Ill. Admin. Code tit. 26, pt. 216, exh. H

Current through Register Vol. 48, No. 36, September 6, 2024

Exhibit H - Address Correction for Fail Safe Voter

Mandated

December, 1995

SBE No. C-6

ADDRESS CORRECTION FOR FAIL-SAFE VOTER

[] FEDERAL BALLOT ONLY

* Voters who change residence to another address within Election Authority's jurisdiction.

* Voting in former residence polling place or when applying for absentee ballot.

Social Security Number (last four numbers: ______________________________

Date of Birth: ________________________

Voter's Full Name (Please Print):

__________________________________________________________________

Current Address:

__________________________________________________________________

City/Village ___________________________ Zip Code _________________

Former Address:

__________________________________________________________________

City/Village ___________________________ Zip Code _________________

____________________________________

DateSignature of Voter or Mark

Ill. Admin. Code tit. 26, pt. 216, exh. H