Application to Vote by Mail

Kathy Michael
McLean County Clerk
PO Box 1328
Bloomington, IL 61702-1328

General Election, November 8, 2022

County

Phone Number

Political Party (only used for Primary Elections)

Permanent Vote by Mail

I wish to receive a Vote by Mail ballot at all future elections that do not rquire a party designation. (ex. General, Municipal)

I wish to receive a Vote by Mail ballot for all subsequent elections, and I wish to receive a REPUBLICAN party Vote by Mail ballot in elections that require a party designation.

I wish to receive a Vote by Mail ballot for all subsequent elections, and I wish to receive a DEMOCRATIC party Vote by Mail ballot in elections that require a party designation.

I wish to receive a Vote by Mail ballot for all subsequent elections, and I wish to receive a LIBERTARIAN party Vote by Mail ballot in elections that require a party designation.

I wish to receive a Vote by Mail ballot for all subsequent elections, and I wish to receive a NON-PARTISAN Vote by Mail ballot in elections that require a party designation.

I wish to receive a ballot for the November 8, 2022 General election ONLY

Ballots will not be available until the beginning of October. If you have not heard from us or received your ballot by October 10 or within 5 days from the day you submitted your request (if request was made after October 4) please call our office at 309-888-4035.

This application must be received at least 5 days prior to an Election.

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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 absentee ballot. I hereby make application for an official ballot or ballots to be voted by me at such election, and I agree that I shall return such ballot or ballots to the 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 midnight election day, and received 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 absentee ballot or ballots to be voted by me at the election specified in this application and that I must submit a separate application for an official absentee ballot or ballots to be voted by me at any subsequent election. Under penalties as provided by law pursuant to 10 ILCS 5/29-10, the undersigned certifies that the statements set forth in this application are true and correct.