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.
* Please fill in as many details as you can provide
at the voting center or DropBox for
3. I hereby declare that I intended to and did indeed make the following selections on my ballot at the time of my vote.
* May not apply to your ballot
* May not apply to your ballot
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.
