ILLINOIS VOTER REGISTRATION APPLICATION
FORM 275 W
Rv. 11/20
TO VOTE YOU MUST:
n Be a United States citizen.
n Be at least 18 years old on or before the next election—
or for a March Primary, be 18 years old by the date of
the following November General Election.
n Live in your election precinct at least 30 days before
the next election.
n Not be convicted and in jail.
n Not claim the right to vote anywhere else.
YOU CAN USE THIS FORM TO:
n Apply to register to vote in the State of Illinois.
n Change your address on your voter registration record.
n Change your name on your voter registration record.
DEADLINE INFORMATION:
n Mail or deliver this form no later than 28 days
before the next election.
n If you do not receive a notice within 4 weeks of
mailing or delivering this application, call the Board
of Elections at 312-269-7960.
RETURN THIS FORM TO:
n Chicago Board of Elections
69 W. Washington St. #600
Chicago, IL 60602
IMPORTANT INFORMATION:
n First-time voters who register by mail must show proof of identification in order
to vote. You may be able to satisfy this requirement by providing your driver’s
license number or a State of Illinois identification card number. If you do not have
either of these, you may provide the last four digits of your social security number
on this form. If we are able to verify your identity with one of these numbers, it
will not be necessary for you to show identification in order to vote.
If we cannot verify your identity through a valid driver’s license number, State
of Illinois identication card number or social security number, you will need to
provide identication before you can vote.
Acceptable forms of identification include:
• a copy of a current and valid photo identification;
• a copy of a current utility bill, bank statement, government check,
paycheck, or other government document that shows your name & address.
A copy
of your identication can be mailed in an envelope to this oce
along with this registration form, or can be shown the rst time you vote.
n If you register by mail, you must vote in person the first time you vote—except
that you may vote by mail if sufficient proof of identification, as described
above, is submitted with the vote by mail.
n If you register at a public service agency, any information regarding the
agency which assisted you will remain confidential as will any decision
not to register.
n If you change your name, you must re-register.
Office Use
10.
Phone number (optional)
( ) -
11 . ID number – check the applicable box and provide the appropriate number
IL Driver’s License or, if none, Sec. of State identification or
Last 4 digits of Social Security Number
I have none of the above-listed identification numbers.
______________________________________________________________
13. Voter Affidavit – Read all statements and sign within the box to the right.
I swear or arm that:
•
I am a citizen of the United States;
•
I will be at least 18 years old on or before the next election;
•
I will have lived in the State of Illinois and in my election precinct at least
30 days as of the date of the next election;
•
The information I have provided is true to the best of my knowledge
under penalty of perjury. If I have provided false information, then I may
be fined, imprisoned, or if I am not a U.S. citizen, deported from or
refused entry into the United States.
This is my signature or mark in the space below
Today’s Date:
___________/___________/_________
FOLD ON DOTTED LINE, SEAL AND MAIL
TYPE OR PRINT CLEARLY IN BLACK OR BLUE INK
Fold Line
12 .
1. Are you a citizen of the United States of America? (check one) Yes No
2. Will you be 18 years of age on or before election day? (check one) Yes No
If you checked “no” in response to either of these questions, then do not complete this form.
3.
You can use this form to: (Check One) apply to register to vote in Illinois change your address change your name
4. Last Name First Name Middle Name or Initial Suffix (Check One) Jr. Sr. II III IV
5. Address where you live (House No., Street Name, Apt. No.) City/Village/Town Zip Code County
6. Mailing address (P.O. Box) City/Village/Town, State Zip Code Email (optional)
7.
Former Registration Address (include City and State and Zip Code) Former County
8.
Former Name (if changed)
9. Date of Birth MM/DD/YY
Sex (check one)
M F
( ) -
Jr. Sr. II III IV
______/______/___________
14. If you cannot sign your name, ask the person who helped you fill in this form to print their name, address and telephone number
Name of person assisting Full Address Telephone No.
15.
I request a Vote By Mail ballot for the November 3, 2020 General Election (check one) Yes No
Note: A first time voter registering by mail must provide proof of identify. See box 11 above.
