Vote by Mail Application
Note: Only residents in Wayne, Winfield and Naperville Township are eligible to vote in the February 28, 2017, Consolidate Primary Election.
I hereby make application for an official ballot(s) to be voted at the Election on
Tuesday, February 28, 2017 in DuPage County and the State of Illinois. I agree that I shall return the ballot(s) to the election authority issuing the same prior to the closing of the polls on the date of the election or, if returned by mail, postmarked no later than Election Day, for counting no later than during the period for counting provisional ballots, the last day of which is the 14th day following Election Day.
I state that I am residing at the address designated below. I have lived at said address for 30 or more days preceding this election, and that I am lawfully entitled to vote in such precinct at said election to be held herein.
I understand that this application is made for an official Vote by Mail ballot or ballots to be voted by me at the election specified in this application and that I must submit a separate application for an official Vote by Mail ballot or ballots to be voted by me at any subsequent election.
Under penalties provided by law pursuant to 10 ILCS 5/29-10, the undersigned certifies that the statements set forth in this application are true and correct.
For the Consolidated Primary Election Only: I request a ballot for the Party.
Name and Address of Voter
Date of Birth:
Wednesday, January 01, 1975 (Left-click calendar icon to select date)
Street Address: (DuPage County only)
Email address (optional):
Address to which the ballot is to be mailed (if different from above)
Mail Address line 1:
Mail Address line 2: