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General Primary Petition - Illinois

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10 ILCS 5/7-10, 7-10.2

X...BIND HERE...X

Suggested

Revised May, 2009

SBE No. P-10

GENERAL

PRIMARY PETITION

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

of the _________________________ Party, in the ____________________ of _________________________ in the County

of ____________________, and State of Illinois, do hereby petition that the following named person or persons shall be a

candidate(s) of the _________________________ Party for the nomination/election for the office or offices hereinafter specified

to be voted for at the Primary Election to be held on _________________________(date of election).

NAME

OFFICE

ADDRESS

If required pursuant to 10 ILCS 5/7-10.2, 8-8.1 or 10-5.1, 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

State of _________________________

)

SS.

County of ________________________

)

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)

__________________________________________________

(SEAL)

(Notary Public’s Signature)

SHEET NO. __________

General Primary Petition - Illinois

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