Form Sbe R-19 - Illinois Voter Registration Application Page 2
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1
2Back of SBE No. R-19
YOUR ADDRESS
________________________
______________
PUT
________________________
FIRST
CLASS
STAMP
________________________
HERE
_______________
___________________________________________________
DuPage County Election
MAIL TO:
Commission
P.O. Box 1087
Wheaton, IL 60187-1087
___________________________________________________
CHANGE OF ADDRESS
PCT
WARD
CODE
ADDRESS
CITY
ZIP
COUNTY
DATE
CLERK
SUSPENSION, CANCELLATION AND REINSTATEMENT
DATE
EXPLAIN
CLERK
DATE
EXPLAIN
CLERK
To Election Judges
Voting Record
08
09
10
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12
13
14
15
16
17
18
19
20
21
22
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24
25
26
For Primary, mark
Primary
D for Democrat
General
R for Republican
NonPartisan
for all other
elections markV
Special
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Parent category: Life