Board of Election Commissioners

P.O. Box 2242

Chicago, Illinois 60690-2242
Charles Holiday, Jr.
Executive Director

!
Dear Voter,
This mailing includes: OR Apply
Online
n Your new voter card, and chicagoe
n Information on applying to Vote By Mail (VBM) and joining the lections.g
ov
Permanent VBM roster To Vote B
y
To learn more about VBM, visit chicagoelections.gov or call (312) 269-7967. Mail

For voter registration services, including name and address changes, go to

chicagoelections.gov or call (312) 269-7936.

Estimado Votante, 尊敬的選民，

Este envío incluye su nueva tarjeta de votante. 這郵件附有你的新選民卡 。

Si usted desea aplicar para Voto Por Correo: 如果你想申請郵寄投票：

n Vaya a eleccioneschicago.com para aplicar en línea para
un Voto Por Correo.
n Para pedir una solicitud en español, envíe un correo electrónico a
HispanicVote@chicagoelections.gov o llame al (312) 269-7967.
Los servicios de registro (para nuevos votantes y para
cambios de nombre y dirección) también están disponibles en
eleccioneschicago.com
n 請到這網站 chicagoelections.gov/Chinese 在網上申請郵寄投票 。
n 如需要中文郵寄表格，請發送電郵至
ChineseVote@chicagoelections.gov 或致電 (312) 269-7967 。
這網站 chicagoelections.gov/Chinese 也提供選民登記服務
(新選民登記及更改姓名和更改地址) 。
Drogi Wyborco,
Zawiadomienie zawiera twoją nową kartę wyborcy.

Jeżeli chcesz głosować korespondencyjnie to:

n Wejdź na stronę internetową chicagowybory.com i złóż wniosek
przez internet.
■ n Wyślij e-mail na adres PolishVote@chicagoelections.gov
chicagoelections.gov/Hindi lub zadzwoń na numer (312) 269-7967 o wysłanie wniosku
HindiVote@chicagoelections.gov w języku polskim.
■
Rejestracja do głosowania dla nowych wyborców, zmiana
nazwiska lub adresu zamieszkania jest dostępna na stronie
chicagowybory.com.
chicagoelections.gov/Hindi

유권자 여러분께,
이 우편물에는 귀하의 새 유권자 카드가 포함되어 있습니다.
우편 투표를 신청하고 싶으시면:
n chicagoelections.gov/Korean 에서 온라인으로 우편 투표를 신청하세요.
n 우편으로 제출할 수 있는 한국어로 된 우편 투표 신청서를 받고 싶으
시면, KoreanVote@chicagoelections.gov 로 이메일을 보내시거나
(312) 269-7967로 전화하세요.
유권자 등록 서비스는 (새로운 유권자 등록과 이름 및 주소 변경)
chicagoelections.gov/Korean 에서도 제공됩니다.
Mahal na Botante,
Kasama sa mail na ito ang iyong bagong voter card.
Kung gusto mong mag-apply sa Bumoto Sa pamamagitan ng Mail:
n Pumunta sa chicagoelections.gov/Tagalog upang mag-apply
online sa Bumoto Sa pamamagitan ng Mail.
n Upang humiling ng form ng mail-in sa Tagalog, magpadala ng
email sa TagalogVote@chicagoelections.gov o tumawag
(312) 269-7967.
Ang mga serbisyo sa pagpaparehistro ng botante (para sa mga bagong
botante at para sa mga pagbabago sa pangalan at mga pagbabago
sa tirahan) ay magagamit din sa chicagoelections.gov/Tagalog
 New Address

Apt. No. Zip

Birth Date Last 4 digits of SS# or Drivers License#

Telephone Date Moved

Signature

PRIMARY ELECTION JUNE 28, 2022

!
Dear Voter, OR Apply
If you want to Vote By Mail at the June 28, 2022 Primary Election: Online
n You can apply online at chicagoelections.gov, or
c h icagoelec
tions.gov
n Use the mail-in application below. If you apply online, do not use the mail-in form below. To Vote B
y
You may also apply to be included in the Permanent Vote By Mail roster online or by using Mail
the form below. Choosing to be on the roster means that you will automatically receive your
Vote By Mail ballot for every election, including the June 28, 2022 Primary Election.
If you are applying for Vote By Mail ballot, please check one box out of the three below.

Application to Vote By Mail for the June 28, 2022 Primary Election – City of Chicago
I hereby swear (or affirm) that I am the voter named above and I personally provided the signature below for my Voter
Registration record and Vote By Mail application.
I state that I am a resident of the Precinct and Ward listed above in the City of Chicago, Cook County, IL; that I have lived at
this address for _____ years and _____ months; I certify I am the voter above, that I reside at the Chicago address listed
above, and that I will have lived there at least 30 days before June 28, 2022 (Election Day), that I am lawfully entitled to vote in
this precinct, and that I wish to Vote By Mail. I hereby make application for an official ballot to be voted by me at this election.
I agree to return said ballot to the Chicago Election Board by the close of polls Election Day, and, if by mail, postmarked by
Election Day to be counted if received within 14 days of Election Day. Under legal penalties provided by 10 ILCS 5/29-10,
I certify all statements in this application are true.
I understand this application is for an official Vote By Mail ballot for the June 28, 2022 election. If there’s a question about my
Vote By Mail Application or my Ballot Return Envelope, please call and/or email me:

Phone: (_______) ________-___________ Email:_____________________________________________________________________

Mail ballot to my registration address above OR to this address below for the next election only:

__________________________________________________________________________________________________________________
ADDRESS APT CITY STATE ZIP

WARNING: Knowingly submitting false information is a Class 3 felony.

Voter,
sign here X
Today’s Date: _____/_____ /______ Voter’s Date of Birth: _____/_____ /_______
MONTH DATE YEAR MONTH DATE YEAR

Application to Join the Permanent Vote By Mail Roster

I wish to receive a Vote By Mail ballot in:
the June 28, 2022 Primary Election ONLY, and I wish to receive a ______________________ Party Vote By Mail ballot
all future elections that do not require a Party designation
all future elections, and I wish to receive a ______________________ Party Vote By Mail ballot in elections that require
a Party designation
The Election Board will begin mailing ballots in May. Call (312) 269-7967 or email VoteByMail@chicagoelections.gov
with any questions.