Illinois Statutes Chapter 10. Elections § 5/20-13. Unregistered persons temporarily absent from county of residence

1. I hereby request a vote by mail ballot to vote for the president and vice-president only .......... (insert date of general election)

2. I am a citizen of the United States and a permanent resident of Illinois.

3. I have maintained, and still maintain, a permanent abode in Illinois for the past .......... years at: .......... (House) .......... (Number) .......... (Street) .......... (City) .......... (Village) .......... (Town)

4. I will not be able to regularly register in person as a voter because .................... (Give reason for temporary absence such as “Student”, “Temporary job transfer”, etc.)

5. I was born .......... (Month) .......... (Day) .......... (Year) in .................... (State or County);

6. To be filled in only by a person who is foreign-born (If answer is “yes” in either a. or b. below, fill in appropriate information in c.):

7. I am not registered as a voter in any other county in the State of Illinois or in any other State.

8. I am not requesting a ballot from any other place and am not voting in any other manner in this election and I have not voted and do not intend to vote in this election at any other address. I request that you mail my ballot to the following address:

(Print name and complete mailing address)

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9. Under penalties as provided by law pursuant to Article 29 of The Election Code, the undersigned certifies that the statements set forth in this application are true and correct.

The procedures set forth in Sections 20-4 through 20-12 of this Article, insofar as they may be made applicable, shall be applicable to vote by mail voting under this Section.