Copy of Vote by Mail Request
Per 10ILCS 5/19-6
Completed Vote by Mail Ballots must be returned to the Danville Election Commission via United States Post Office.
Danville Election Commission, March 15, 2022 General Primary Election
First and Last Name
Where You Live (including Zip Code)
Where You Want Your Ballot Mailed (Including Zip Code)
SSN - Last 4 digits only
I certify that I reside at the address specified above, in the stated precinct and 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. I hereby make application for an official ballot or ballots to be voted by me at such election and agree that I shall return such ballot or ballots to official issuing the same prior to the closing of the polls on the date of election or, if returned by mail, postmarked no later than midnight preceding 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 or ballots to be voted by me at any subsequent elections. Under penalties as provided by law pursuant to Section 29-10 of the Election Code [10 ILCS 5/29-10], the undersigned certifies that the statements set forth in this application are true and correct.
A copy of your responses will be emailed to the address you provided.
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