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| 1 | | address for .... month(s)
last past; that I am lawfully |
| 2 | | entitled to vote in such precinct at the
.... election to be |
| 3 | | held therein on ....; and that I wish to vote by vote by mail |
| 4 | | ballot. |
| 5 | | I hereby make application for an official ballot or ballots |
| 6 | | to be
voted by me at such election, and I agree that I shall |
| 7 | | return such ballot or ballots to the
official issuing the same |
| 8 | | prior to the closing of the polls on the date
of the election |
| 9 | | or, if returned by mail, postmarked no later than election day, |
| 10 | | for counting no later than during the period for counting |
| 11 | | provisional ballots, the last day of which is the 14th day |
| 12 | | following election day. |
| 13 | | I understand that this application is made for an official |
| 14 | | vote by mail ballot or ballots to be voted by me at the |
| 15 | | election specified in this application and that I must submit a |
| 16 | | separate application for an official vote by mail ballot or |
| 17 | | ballots to be voted by me at any subsequent election. |
| 18 | | Under penalties as provided by law pursuant to Section |
| 19 | | 29-10 of the
Election Code, the undersigned certifies that the |
| 20 | | statements set forth
in this application are true and correct. |
| 21 | | .... |
| 22 | | *fill in either (1), (2) or (3). |
| 23 | | Post office address to which ballot is mailed: |
| 24 | | ............... |
| 25 | | However, if application is made for a primary election |
| 26 | | ballot, such
application shall require the applicant to |
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| | 10000HB2805ham001 | - 3 - | LRB100 09571 MLM 24293 a |
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| 1 | | designate the name of the political party with which
the |
| 2 | | applicant is affiliated. |
| 3 | | If application is made electronically, the applicant shall |
| 4 | | mark the box associated with the above described statement |
| 5 | | included as part of the online application certifying that the |
| 6 | | statements set forth in this application are true and correct, |
| 7 | | and a signature is not required. |
| 8 | | Any person may produce, reproduce, distribute, or return to |
| 9 | | an election authority the application for vote by mail ballot. |
| 10 | | If applications are sent to a post office box controlled by any |
| 11 | | individual or organization that is not an election authority, |
| 12 | | those applications shall (i) include a valid and current phone |
| 13 | | number for the individual or organization controlling the post |
| 14 | | office box and (ii) be turned over to the appropriate election |
| 15 | | authority within 7 days of receipt or, if received within 2 |
| 16 | | weeks of the election in which an applicant intends to vote, |
| 17 | | within 2 days of receipt. Failure to turn over the applications |
| 18 | | in compliance with this paragraph shall constitute a violation |
| 19 | | of this Code and shall be punishable as a petty offense with a |
| 20 | | fine of $100 per application. Removing, tampering with, or |
| 21 | | otherwise knowingly making the postmark on the application |
| 22 | | unreadable by the election authority shall establish a |
| 23 | | rebuttable presumption of a violation of this paragraph. Upon |
| 24 | | receipt, the appropriate election authority shall accept and |
| 25 | | promptly process any application for vote by mail ballot |
| 26 | | submitted in a form substantially similar to that required by |