§216.EXHIBIT E. ..Voter Identification Card

10 ILCS 5/4-15, 5-21, 6-57	Suggested
	Revised July, 1995
	SBE No. R-15
SUGGESTED VOTER I.D. CARD

 

			VOTERS CERTIFICATE OF REGISTRATION
	Polling Place		(DISPOSITION OF REGISTRATION)

 

CONG.

LEG.

REP.

CO. BD.

I hereby certify that the person whose name and address appears

City/Village

below is a registered voter.

PCT.

WARD

TWP.

Elem. Sch. Dist.

County Clerk/Exec. Director

Jurisdiction

High Sch. Dist.

Twp.

Pct/Ward

Comm. Coll. Dist.

Name

Sanitary Dist.

Street No.

Street Name

Fire Dist.

Apt. No.

Park Dist.

City

State

Zip

Cem. Dist.

Date Issued

Judicial District

Judicial Circuit

(DO NOT DETACH)

(RETAIN THIS CARD)

(See reverse side)

	SBE No. R-15 Reverse Side
SUGGESTED VOTER I.D. CARD

 

For Information Regarding Elections,

If you move to another address within________________________, print your new address, sign your name and mail to______________ __________________________.  Voters changing their names must reregister.

Voter Registration Contact

Name of Election Authority

New Address:

Twp.

Pct.

Address

Street Address

or RFD No.

City

If RFD Include County House No.

Rd. No

State

Zip

City

State

Zip

Date Moved

Telephone

Signature

(Change of Address cannot be accepted in the 28 Days Preceding an election)