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Application for Vote by Mail Ballot

General Election - November 3rd, 2020

I certify that I reside at the address specified above, in the stated precinct in Sangamon County,
that I have lived at such address for 30 days or more preceding this election, that I am lawfully
entitled to vote in such precinct at said election to be held therein, and that I wish to vote by mail ballot.

I hereby make application for an official ballot to be voted by me at such election, and I agree that
I shall return such ballot to the election official 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 understand that this application is made for an official vote by mail ballot 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 to be voted by me at any subsequent election.

Under the penalties as provided by law pursuant to 10 ILCS 5/29-10 of the Election Code, the undersigned certifies that the statements set forth in this application are true and correct.
Address to which ballot is mailed: (ONLY if outside of Sangamon County)

This application MUST be received by October 29th, 2020 (at least 5 days prior to an Election).