In the State of Illinois )
I, the undersigned Affiant, do hereby state under penalty of perjury that I have personal knowledge of the
matters stated herein and that if called to testify I would state the same.
4. At the above time and place, the following occurred (fill out all that apply):
a. The voting center was not open for
I was unable to vote because the voting center was not open and I could not wait for the following reason
b. The Election Judge(s) would not allow me to vote because:
c. I witnessed someone outwardly supporting a candidate or political party within 100 feet of the voting center. Specifically, I witnessed the following:
FURTHER AFFIANT SAYETH NOT
Under penalties as provided by the law pursuant to Section 1-109 of Illinois Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters therein stated to be information and belief, and as to such matters the undersigned certifies as aforesaid that he/she verily believes the same to be true.
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