Illinois Voter Registration Application

This screen creates a PDF Form with your input so you can print and mail it into the office.

Instructions:

Please answer below questions and complete sections 1-10.
Once complete, click the "Submit" button at the bottom to create and view the PDF form.
Print and sign the PDF form before mailing it to the County Clerk's Office.

If you just want to print a blank form, click here.

Are you a citizen of the United States of America?	(check one)	Yes No
Will you be 18 years of age on or before Election Day?	(check one)	Yes No

If you check "no" in response to either of these questions, do not complete this form.

Check applicable box:

Applying to vote in Illinois

Changing address

Changing name

1. Last Name	First Name	Middle Name or Initial	Suffix (Select one)

2. Address where you live: (House No., Street Name, Apt. No.)	City/Village/Town

Zip Code	County

3. Mailing address: (Post Office Box)	City/Village/Town	Zip Code

4. Former Registration Address: (include City, State and Zip Code)	Former County

5. Former Name (If changed)

6. Date of Birth: MM/DD/YY

7. Sex: (select one)

M F

8. Daytime telephone number
including area code:

() -

9. ID number – check the applicable box and provide the appropriate ID# below

IL Driver’s License or, if none, IL Secretary of State ID or

Last 4 digits of Social Security Number

I have none of the identification numbers listed above

ID#

10. Voter Affidavit - Check all true statements and sign within the box to the right.
I swear or affirm that:

I am a citizen of the United States;

I will be at least 18 years old on or before the next election;

I will have lived in the State of Illinois and in my election precinct at least 30 days as of the date of the next election;

The information I have provided is true to the best of my knowledge under penalty of perjury. If I have provided false information, then I may be fined, imprisoned, or if I am not a U.S. citizen, deported from or refused entry into the United States.

Today's Date // mm/dd/yyyy

Illinois Voter Registration Application

Click the SUBMIT button to create and view the PDF Form.