Petition For Nomination And Formation Of A New Political Party (In Counties In Which Officers Are To Be Elected From Districts And At-Large)
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110 ILCS 5/10-2, 10-4, 10-5.1
X...BIND HERE...X
Suggested
Revised May, 2009
SBE No. P-8B
PETITION FOR NOMINATION AND FORMATION OF A NEW POLITICAL PARTY
(IN COUNTIES IN WHICH OFFICERS ARE TO BE ELECTED FROM DISTRICTS AND AT-LARGE)
We, the undersigned, qualified voters of District Number __________ in the County of ____________________, State of Illinois, do
hereby declare that it is our intention to form a new political party in such county to be known as the _________________________
Party and the following named persons shall be candidates of such party for the offices hereinafter specified to be voted at the election
.
to be held on _________________________ (date of election)
NAMES OF CANDIDATES FOR ALL OFFICES TO BE ELECTED AT-LARGE
NAME OF CANDIDATE
COUNTY OFFICE
ADDRESS - ZIP CODE
NAMES OF CANDIDATES FOR ALL OFFICES TO BE ELECTED BY DISTRICTS
OFFICE OF COUNTY
NAME OF CANDIDATE
BOARD MEMBER
ADDRESS - ZIP CODE
District No.
District No.
District No.
District No.
For any candidate subject to the requirements of 10 ILCS 5/10-5.1, mark his/her name with an asterisk (*) and 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
State of _________________________
)
)
SS.
County of ________________________
)
I, ______________________________________ do hereby certify that I reside at _________________________________________,
(Circulator’s Name)
(Street Address)
in the ______________________________ of _______________________________________________________, _____________,
(City/Village/Unincorporated Area)
(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 registered voters of the political division in which the candidate is seeking 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)
__________________________________________________
(SEAL)
(Notary Public’s Signature)
SHEET NO. __________
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