FOR UNIFORMED SERVICES AND U.S. CITIZENS OVERSEAS

FEDERAL POST CARD APPLICATION (FPCA) DESCRIPTION

Who May Use This Application

Block 1 Instructions. Place a checkmark only in one block. Marking 1c. generally means that you were a resident of that state before departing the U.S. and your intent to return at some time in the future is uncertain. Marking block 1.c. applies for a Federal ballot only (if one is printed by the state).

1. I REQUEST ABSENTEE BALLOTS FOR ALL ELECTIONS IN WHICH I AM ELIGIBLE TO VOTE AND I AM (Mark only one)

Type of UOCAVA Voter Required

(a) A Member Of The Uniformed Services Or Merchant Marine On Active Duty, or An Eligible Spouse Or Dependent
(b) A U.S. Citizen Residing Outside The U.S. Temporarily
(c) A U.S. Citizen Residing Outside The U.S. Indefinitely
________________________________________

Block 2 Instructions. MY INFORMATION. Block 2d. RACE. This information is requested from some states for statistical purposes by the Department of Justice in their enforcement of the Voting Rights Act and the National Voter Registration Act. See Voting Assistance Guide.

2. MY INFORMATION
a. Typed Name (Required): Last name. First name. Middle name. Please enter your suffix, e.g., Jr. Sr. III, etc., if applicable
b. Previous Name (if applicable)Please enter your previous surname
c. Sex (Check Box -- choose only one): Male or Female.
d. Race.Please enter the appropriate race code as listed in the Voting Assistance Guide pages for your state.
e. Date of Birth.Please enter your date of birth in the following format: eight digits, Month, Month, Day, Day, Year Year Year Year (MMDDYYYY)
f. Social Security Number. Only the last four digits of the Social Security Number are required when you do not have a State Driver's License or ID Number. Some states require the entire number as well as the Driver's License or ID Number. Check the Voting Assistance Guide for those states.
g. State Driver's License or ID Number. If you do not have a State Driver's License or ID Number, make sure you complete section 2.f. above.
h.Telephone Number (No DSN number, include all international prefixes)
i.Fax Number (No DSN number, include all international prefixes)
j.Email Address
________________________________________
Block 3. Instructions. MY VOTING RESIDENCE ADDRESS. Enter the complete legal voting residence address (including county) where you ACTUALLY LIVED in the state or territory. Your right to vote in your state and determination of your voting precinct depend on the physical location of your residence while you were in the state. DO NOT USE A POST OFFICE BOX NUMBER. In an area with no street names, indicate route name and number and box number. Also provide any additional information necessary to physically describe your residence location. If you have never lived in the U.S., check the Guide for the states that allow you to vote using a relative's voting residence.

3. My Voting Residence Address Required (For military, use legal residence. For overseas citizen, use last legal residence in U.S.)
a. Number and Street (Cannot be a P.O. Box) (Required)
b. City, Town or Village
c. County
d. State
e. Zip Code. Please enter the five digit zip code. If known, please enter the last four digits of the zip code
________________________________________
Block 4. Instructions. WHERE TO SEND MY VOTING MATERIALS. Item 4a.is the complete mailing address where you are now living. If you have an alternate address or an address of a mail forwarding service that delivers your mail more quickly, enter that address in Item 4b. If your state allows absentee ballots to be sent via e-mail or fax, check the appropriate box in Item 4c. See Voting Assistance Guide This form should be resubmitted every time you change your mailing address.

4. Where to Send My Voting Materials
a. My Current Address Required: (Where I live now)(Required)
b. My Forwarding Address: (NOTE: complete 4.b. only if you do not want your ballot mailed to the address in block 4.a.)
c. I prefer to receive my absentee ballot, as permitted by my State. By (Check Box -- choose only one): Mail, Fax, Email.
________________________________________
Block 5. Instructions. MY POLITICAL PARTY PREFERENCE. This is an optional entry, however, this information is required by most states in order to vote in primary elections. Consult the Voting Assistance Guide for any state information required.

5. My Political Party Preference (Optional, but may be required by states to register to vote in primary elections).
________________________________________
Block 6. Instructions. ADDITIONAL INFORMATION.

(1) Provide any information that may assist the local election official in approving this application. It would be helpful if you provide the date you last lived at the address in Block 3.a. and if you list a name and telephone number of a local contact in the event the local election official cannot contact you and has a question concerning the application.

(2) If you were previously registered to vote in a jurisdiction other than the one in which you are applying, indicate "previously registered in (location)."

(3) If you are NOT requesting absentee ballots for all Federal elections (state and local elections where applicable), including Primary, Special, Runoff and General elections, note in Item 6 the election for which you are requesting the absentee ballot, i.e.,"Primary election only".

(4) If your state provides a special state write-in ballot and you are requesting one, indicate the reason you are requesting a special write-in ballot or place a sticker from the Voting Assistance Guide in this section.
6. Additional Information (See instructions above and consult the Voting Assistance Guide for state instructions.)
________________________________________
Block 7. AFFIRMATION.
I swear or affirm, under penalty of perjury, that:
1. I am a member of the Uniformed Services or merchant marine on active duty or an eligible spouse or dependent of such a member, or a U.S.
citizen temporarily residing outside the U.S., or other U.S. citizen residing outside the U.S., and
2. I am a U.S. citizen, at least 18 years of age (or will be by the day of the election), eligible to vote in the requested jurisdiction, and
3. I have not been convicted of a felony or other disqualifying offense or been adjudicated mentally incompetent, or if so, my voting rights have been reinstated, and
4. I am not registering, requesting a ballot, or voting in any other jurisdiction in the U.S., and
5. My signature and date below indicate when I completed this document, and
6. The information on this form is true and complete to the best of my knowledge.

I understand that a material misstatement of fact in completion of this document may constitute grounds for conviction of perjury.
Signed: Date:
Signed: Date:
(Witness/Notary and address (if required))

Ensure that you read the oath, sign, and enter the date you completed the form in the spaces provided.Not all states require a witness or notary, and state laws vary regarding the voting of convicted felons. Consult your state section of the Voting Assistance Guide or your Voting Assistance Officer for your state's requirements.

7. AFFIRMATION (Required)

Adams; County Clerk, 507 Vermont, PO Box 1169; Quincy, Ill., 62306-1169

Alexander; County Clerk, 2000 Washington; Cairo, Ill., 62914-1717

Bond; County Clerk, 200 W. College; Greenville, Ill., 62246-1088

Boone; County Clerk, 601 N. Main, Suite 202; Belvidere, Ill., 61008-2644

Brown; County Clerk, #1 Court Street; Mount Sterling, Ill., 62353-1285

Bureau; County Clerk, 700 S. Main; Princeton, Ill., 61356-2078

Calhoun; County Clerk, PO Box 187; Hardin, Ill., 62047-0187

Carroll; County Clerk, PO Box 152; Mount Caroll, Ill., 61053-1044

Cass; County Clerk, Courthouse; 100 E. Springfield Street; Virginia, Ill., 62691-1322

Champaign; County Clerk, 1776 E. Washington; Urbana, Ill., 61802-4578

Christian; County Clerk, PO Box 647; Taylorville, Ill., 62568-0647

Clark; County Clerk, Courthouse; 501 Archer Avenue; Marshall, Ill., 62441-1275

Clay; County Clerk, PO Box 160; Louisville, Ill., 62858-0160

Clinton; County Clerk, PO Box 308; Carlyle, Ill., 62231-0308

Coles; County Clerk, 651 Jackson Avenue, Room 122; Charleston, Ill., 61920-2053

Cook; County Clerk, 69 W. Washington, 5th Floor; Chicago, Ill., 60602-1304

Crawford; County Clerk, PO Box 616; Robinson, Ill., 62454-0602

Cumberland; County Clerk, PO Box 146; Toledo, Ill., 62468-0146

De Kalb; County Clerk, 110 E. Sycamore; Sycamore, Ill., 60178-1497

De Witt; County Clerk, 201 W. Washington Street, PO Box 43; Clinton, Ill., 61727-1628

Douglas; County Clerk, PO Box 467; Tuscola, Ill., 61953-0467

Edgar; County Clerk, 115 W. Court Street, Room "J"; Paris, Ill., 61944-1785

Edwards; County Clerk, 50 E. Main Street; Albion, Ill., 62806-1262

Effingham; County Clerk, 101 N. 4th, Box 628; Effingham, Ill., 62401-0628

Fayette; County Clerk, PO Box 401; Vandalia, Ill., 62471-0401.

Ford; County Clerk, 200 W. State Street, Room 101; PO Box 568; Paxton, Ill., 60957-1199

Franklin; County Clerk, 202 W. Main, PO Box 607; Benton, Ill., 62812-0607

Fulton; County Clerk, PO Box 226; Lewistown, Ill., 61542-0226

Gallatin; County Clerk, PO Box 550; Shawneetown, Ill., 62984-0550

Greene; County Clerk, 519 N. Main; Carrollton, Ill., 62016-1033

Grundy; County Clerk, 111 E. Washington, PO Box 675; Morris, Ill., 60450-0675

Hamilton; County Clerk, Courthouse; 100 S. Jackson Street; McLeansboro, Ill., 62859-1489

Hancock; County Clerk, Courthouse; PO Box 39; Carthage, Ill., 62321-0039

Hardin; County Clerk, Courthouse; PO Box 187; Elizabethtown, Ill., 62931-0187

Henderson; County Clerk, Courthouse; PO Box 308; Oquawka, Ill., 61469-0308

Henry; County Clerk, 307 W. Center Street; Cambridge, Ill., 61238-1232

Iroquois; County Clerk, 1001 E. Grant; Watseka, Ill., 60970-1882

Jackson; County Clerk, Courthouse; 1001 Walnut; Murphysboro, Ill., 62966-2177

Jasper; County Clerk, 204 W. Washington; Newton, Ill., 62448-1973

Jefferson; County Clerk, 100 South 10th Street, Room 105, Mount Vernon, Ill., 62864

Jersey; County Clerk, 201 W. Pearl; Jerseyville, Ill., 62052-1662

Jo Daviess; County Clerk, 330 N. Bench; Galena, Ill., 61036-1323

Johnson; County Clerk, PO Box 96; Vienna, Ill., 62995-0096.

Kane; County Clerk, 719 S. Batavia, PO Box 70; Geneva, Ill., 60134-0070

Kankakee; County Clerk, 189 E. Court Street; Kankakee, Ill., 60901-3892

Kendall; County Clerk, 111 W. Fox; Yorkville, Ill., 60560-1621

Knox; County Clerk, Courthouse; 200 S. Cherry Street; Galesburg, Ill., 61401-4991

Lake; County Clerk, 18 N. County Road, Room 101; Waukegan, Ill., 60085-4364

La Salle; County Clerk, 707 Etna Road, PO Box 430; Ottawa, Ill., 61350-0430

Lawrence; County Clerk, Courthouse; 1100 State Street; Lawrenceville, Ill., 62439-2341

Lee; County Clerk, PO Box 329; Dixon, Ill., 61021-0385

Livingston; County Clerk, 112 W. Madison Street; Pontiac, Ill., 61764-1629.

Logan; County Clerk, PO Box 278; Lincoln, Ill., 62656-0278

Macon; County Clerk, 141 S. Main, Room 104; Decatur, Ill., 62523-1235

Macoupin; County Clerk, PO Box 107; Carlinville, Ill., 62626-0107

Madison; County Clerk, 157 N. Main Street, Suite 109, PO Box 218; Edwardsville, Ill., 62025-0218

Marion; County Clerk, PO Box 637; Salem, Ill., 62881-0637

Marshall; County Clerk, 122 N. Prairie, PO Box 328; Lacon, Ill., 61540-0328

Mason; County Clerk, PO Box 77; Havana, Ill., 62644-0077

Massac; County Clerk, PO Box 429; Metropolis, Ill., 62960-0429

McDonough; County Clerk, Elections #10 McDonough Co Courthouse Macomb, Ill., 61455-2200

McHenry; County Clerk, 2200 N. Seminary Avenue; Woodstock, Ill., 60098-2693

McLean; County Clerk, 115 E. Washington, Room 102, Box 2400; Bloomington, Ill., 61702-2400

Menard; County Clerk, PO Box 465; Petersburg, Ill., 62675-0465

Mercer; County Clerk, PO Box 66; Aledo, Ill., 61231-0066

Monroe; County Clerk, 100 S. Main; Waterloo, Ill., 62298-1399

Montgomery; County Clerk, PO Box 595; Hillsboro, Ill., 62049-0465

Morgan; County Clerk, PO Box 1387; Jacksonville, Ill., 62651-1387

Moultrie; County Clerk, Courthouse; 10 S. Main; Sullivan, Ill., 61951-1969

Ogle; County Clerk, Courthouse; PO Box 357; Oregon, Ill., 61061-0357

Peoria; County Clerk, Courthouse; 324 Main Street; Peoria, Ill., 61602-1319

Perry; County Clerk, PO Box 438; Pinckneyville, Ill., 62274-0438

Piatt; County Clerk, 101 W. Washington, PO Box 558; Monticello, Ill., 61856-0558

Pike; County Clerk, Courthouse,; 100 E. Washington Street; Pittsfield, Ill., 62363-1496

Pope; County Clerk, Courthouse; PO Box 216; Golconda, Ill., 62938-0216

Pulaski; County Clerk, Courthouse; PO Box 118; Mound City, Ill., 62963-0109

Putnam; County Clerk, Courthouse; PO Box 236; Hennepin, Ill., 61327-0236

Randolph; County Clerk, Courthouse; 1 Taylor Street, Room 202; Chester, Ill., 62233-0309

Richland; County Clerk, Courthouse; 103 W. Main Street; Olney, Ill., 62450-2170

Rock Island; County Clerk, County Building; 1504 3rd Avenue; Rock Island, Ill., 61201-8646