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Organisation : State Board of Elections
Facility : Voter Registration Application Form
State : Illinois
Country : United States

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** Be a United States citizen Be at least 18 years old (some 17 year olds may vote in the General Primary)
** Live in your election precinct at least 30 days
** Not be convicted and in jail
** Not claim the right to vote anywhere else

** Mail or deliver this application to your County Clerk or Board of Election Commissioners no later than 28 days before thenext election. (click for County Clerk/Election Board listings) or go to

** If you do not have a driver’s license, State Identification Card or social security number, and this form is submitted by mail, andyou have never registered to vote in the jurisdiction you are now registering in, then you must send, with this application, either (i)a copy of a current and valid photo identification, or (ii) a copy of a current utility bill, bank statement, government check, paycheck,or other government document that shows the name and address of the voter. If you do not provide the information required above,then you will be required to provide election officials with either (i)or (ii) described above the first time you vote in person or prior tovoting by mail.

** If you change your name you must re-register.
** If you register at a public service agency, any information regarding the agency that assisted you will remain confidential aswill any decision not to register.
** If you do not receive a Notice within 2 weeks of mailing or delivering this application, call your County Clerk or Board of Election Commissioners.

** Box 1-If you do not have a middle name, leave blank.
** Box 3-If mailing address is same as Box 2, write “same”.
** Box 4-If you have never registered before, leave blank. If you do not remember your former address; provide as much information as possible.
** Box 5-If you have not changed your name, leave blank.

** Box 9-If you have an Illinois Driver’s License or Secretary of StateID, check the first box and fill in the number. If you do not have a Driver’s License or SOS ID, check the second box and fill in the last four digits of your Social Security Number. If you do not have a SSN, check the third box and send a copy of the appropriate document (as described in the “Important Information” section)along with this form.

** 10-Read, date and personally sign your name or make your mark in the box.

If you have questions about completing this form, please call the State Board of Elections at (217)782-4141 or (312)814-6440 (or

1 Comment
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  1. I have been a registered voter for several years now.
    My married name is Dana C Negri.
    Address: 7145 Rye Ridge Trail
    Cherry Valley, IL 61016

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