Vote by Mail Application | Register | Voter Information | Sangamon County Clerk | Don Gray

Application for Permanent Vote by Mail Status

Applicant's First Name:

Applicant's Middle Name:

Applicant's Last Name:

Date of Birth: MM/DD/YYYY

Residence Address:

City/Village:

Residence State:

Zip:

Township:

Precinct Number:

Cell Phone #: ###-###-####

Email:

I do not wish to receive email alerts about the status of my ballot.

I am currently a registered voter and wish to apply for permanent vote by mail status.

I state 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 the next regularly scheduled election, and that:

I wish to vote by mail in ALL subsequent elections that DO NOT require a party designation

-or -

I wish to vote by mail in ALL subsequent elections and wish to receive the party ballot indicated below in all elections that require a party designation.

Democratic
Republican

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.

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.

I agree with the statements above.

Address to which ballot is mailed: (ONLY if outside of Sangamon County)

Full Name:

Address:

City:

State:

Zip:

Phone: (if different than above)

This application MUST be received by November 3rd, 2022 (at least 5 days prior to an Election).