TITLE 26: ELECTIONS
CHAPTER I: STATE BOARD OF ELECTIONS
PART 216 REGISTRATION OF VOTERS
SECTION 216.EXHIBIT B VOTER REGISTRATION INFORMATION


 

Section 216.EXHIBIT B Voter Registration Information

 

Mandated

July, 1995

SBE No. R-24

 

VOTER REGISTRATION INFORMATION

 

"If you are not registered to vote where you live now, would you like to apply to register here today?"

IMPORTANT!

 

(Public assistance agencies include the following:

"Applying to register or declining to register to vote will not affect the amount of assistance that you will be provided by this agency.")

If you would like help filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the application in private.

 

 

IF YOU DO NOT CHECK EITHER BOX, YOU WILL BE CONSIDERED TO HAVE DECIDED NOT TO REGISTER TO VOTE AT THIS TIME.

 

YES NO

__________________________________________

Signature

All information will remain confidential and will be used only for voter registration purposes. Anyone not choosing to register to vote and/or information regarding the office to which the application was submitted will remain confidential, to be used only for voter registration purposes.

 

 

___________________________________

Please Print Full Name

month day year

 

____________________________________________________

Date

 

 

(tear here)

------------------------------------------------------------------------------------------------------------COMPLAINT INFORMATION

If you believe that someone has interfered with your right to register or decline to register to vote, your right to privacy in deciding whether to register or in applying to register to vote, or your right to choose your own political party or other political preference, you may file a complaint with Ronald D. Michaelson, Executive Director, State Board of Elections, 1020 South Spring Street, Springfield, Illinois 62704-2999 (217)782-4141 or TDD (217)782-1518.

 

(Half 8 " x 11" sheet)