Fillable Form 18: ILLINOIS VOTER REGISTRATION APPLICATION (Lake County)

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Form 18: ILLINOIS VOTER REGISTRATION APPLICATION (Lake County)

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The Form 18: ILLINOIS VOTER REGISTRATION APPLICATION (Lake County) form is 1 page long and contains:

  • 0 signatures
  • 7 check-boxes
  • 38 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Lake County

BROWSE LAKE COUNTY (IL) FORMS

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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 next election? (Check one) Yes No
If you check “no” in response to either of these questions, do not complete this form.
Eligible 17 year olds may register and vote in primaries. (See instructions above)
3. LastName FirstName MiddleNameorInitial Sux(Jr. Sr. ll lll lV)
4. Address where you live (House No., Street Name) Apt/Unit/Lot City/Village/Town Zip County
5. Mailing Address (P.O. Box, if dierent from above) City/Village/Town Zip
6. Former Registration Address (Include City, State and Zip Code) Former County 7. Former Name (If changed)
8. Date of Birth Month Day Year
9. Sex(Circle one)
M F
10. Telephone Number (Optional)
11. E-mail Address (Optional)
13. VoterAdavit
Iswearorarmthat:
I am a citizen of the United States;
Iwillbeatleast18yearsoldonorbeforethenextelection
(orthenextGeneralorConsolidated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;
This 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ned,
imprisoned, or if I am not a U.S. citizen, deported from or refused entry into
the United States.
14. Ifyoucannotsignyourname,askthepersonwhohelpedyoullinthisformtoprinttheirname,addressandtelephonenumber.
Name of person assisting Full address Telephone number ( )
TO VOTE YOU MUST:
• Be a United States citizen.
• Be at least 18 years old.
(17 year olds may register and vote in primary elections if
18
th
birthdayoccursbeforethenextGeneralConsolidated
orGeneralelection.)
• Liveinyourelectionprecinctatleast30daysbeforethenextelection.
• Not be convicted and in jail.
• Not claim the right to vote anywhere else.
YOU CAN USE THIS FORM TO:
• Apply to register to vote in the State of Illinois.
•
Change your address on your current voter registration record.
• Change your name on your current voter registration record.
When you move or change your name, complete a new registration.
DEADLINE INFORMATION:
• Mailordeliverthisformnolaterthan28daysbeforenextelection.
• If you do not receive a notice within 2 weeks of mailing or delivering
this application, call Lake County’s Voter Services at (847) 377-2410.
CONTACT INFORMATION:
Youcanmailordeliverthisapplicationto:
Robin M. O’Connor, Lake County Clerk
Room 101, 18 North County Street, Waukegan, IL 60085
IMPORTANT INFORMATION:
If you have never registered to vote in this jurisdiction and you do not have an
Illinoisdriver’slicense,IllinoisSecretaryofStateidenticationcardorSocial
Security number, you must send either a copy of a current and valid
photoidenticationoracopyofacurrentutilitybill,bankstatement,
government check, paycheck or other government document listing
your name and current address. Without one of these, you will be
requiredtoprovideelectionocialswithidenticationasdescribed
abovethersttimeyouvote.
If you register at a public service agency, any information
regardingtheagencywhichassistedyouwillremaincondential
as will any decision not to register.
TO COMPLETE THIS FORM:
• Box3–Ifyoudonothaveamiddlename,leaveblank.
• Box5–IfmailingaddressissameasBox4,write“same.”
• Box6–Ifyouhaveneverregisteredbefore,leaveblank.Ifyou
do not remember your former address; provide street, city, and
state.
• Box7–Ifyouhavenotchangedyourname,leaveblank.
• Box11–Byprovidinganemailaddress,youagreetoreceive
election related notices via email.
• Box 12–If you have an Illinois driver’s license, or Illinois
SecretaryofStateidenticationcard,checktherstboxandll
in the number. If you do not have an Illinois driver’s license or
SOSID,checkthesecondboxandllinthelastfourdigitsof
your Social Security number. If you do not have a SSN, check
thethirdboxandsendacopyoftheappropriatedocument(as
describedinthe“ImportantInformation”section)alongwiththis
form.
• Box13–Read,dateandpersonallysignyournameormake
yourmarkinthebox.
TYPE OR PRINT CLEARLY IN BLACK INK
Thisismysignatureormarkinthecenteroftheboxbelow.
Today’sDate:_________/_________/_______________
OFFICE USE
REV 7/2020
12. ID Number
(Check the applicable box and provide the appropriate number on the line below.)
ILdriver’slicenseorStateID#__________—___________—______________
Last 4 digits of Social Security number XXX-XX- _____________________
I have none of the ID numbers listed above.
x______________________________________
ILLINOIS VOTER REGISTRATION APPLICATION
I would like to request a Vote by Mail Ballot for the November 3, 2020 General Election. Yes No
Please check the appropriate box.
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Form 18: ILLINOIS VOTER REGISTRATION APPLICATION (Lake County)

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Completed 6 August 2020

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