County Board Member Primary Petition - Illinois, printable pdf download

X…BIND HERE…X

10 ILCS 5/7-10, 7-10.2

COUNTY BOARD MEMBER

(counties that elect members from districts)

PRIMARY PETITION

We, the undersigned, members of and affiliated with the ________________________ Party and qualified primary

electors of the __________________ Party, in County Board District ________, County of Adams in the State of Illinois, do

hereby petition that __________________________ who resides at _____________________________________________

in the City, Village, Unincorporated Area (circle one) of ________________________ (if unincorporated, list municipality

that provides postal service) Zip Code ______________________County of Adams and State of Illinois, shall be a candidate

of the ________________________Party for the nomination for the office of COUNTY BOARD MEMBER, County Board

District ______________________ in the County of Adams in the State of Illinois, to be voted for at the primary election to

be held on ________________________(date of election).

If required pursuant to 10 ILCS 5/7-10.2 complete the following (this information will appear on the ballot)

FORMERLY KNOWN AS __________________________ UNTIL NAME CHANGED ON ______________________

(List all names during last 3 years)

(List date of each name change)

NAME

STREET ADDRESS OR

CITY, TOWN OR

(VOTER’S SIGNATURE)

RR NUMBER

VILLAGE

COUNTY

1__________________________________________________________________________________________IL

2__________________________________________________________________________________________IL

3__________________________________________________________________________________________IL

4__________________________________________________________________________________________IL

5__________________________________________________________________________________________IL

6__________________________________________________________________________________________IL

7__________________________________________________________________________________________IL

8__________________________________________________________________________________________IL

9__________________________________________________________________________________________IL

10_________________________________________________________________________________________IL

11_________________________________________________________________________________________IL

12_________________________________________________________________________________________IL

State of Illinois )

) SS.

County of Adams)

I, ___________________________ (Circulator’s Name) do hereby certify that I reside at ____________________________,

in the City/Village/Unincorporated Area (circle one) of ________________________________________________________

(if unincorporated, list municipality that provides postal service) Zip Code _________________, County of

_______________, State of _______________, that I am 18 years of age or older, that I am a citizen of the United States, and

that the signatures on this sheet were signed in my presence, not more than 90 days preceding the last day for filing of the

petitions and are genuine and that to the best of my knowledge and belief the persons so signing were at the time of signing

the petition qualified voters of the ____________________ Party in the political division in which the candidate is seeking

nomination/elective office, and that their respective residences are correctly stated, as above set forth.

______________________________________

(Circulator’s Signature)

Signed and sworn to (or affirmed) by ___________________________________ before me, on _______________________

(Name of Circulator)

(insert month, day, year)

_______________________________________

(Notary Public’s Signature)

(SEAL)

SHEET NO. ____________

County Board Member Primary Petition - Illinois,

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