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* Please Print or Type (See instructions at bottom of page)

 

This form can be completed electronically. You must print the form to sign your name and mail after completing.

 

Contact Information

 

Voter’s Name: 

Home Address: 

City, Village, Office: 

County: 

Zip Code: 

Email Address: 

Phone Number: 

Send Ballot to:

(If different from home address)

Name: 

care of/PO Box: 

Address: 

City: 

State: 

Zip Code: 

 

You must provide your birthdate: and one of the following:

 

Your Ohio driver’s license number

 

The last four digits of your social security number

 

Copy of a current and valid photo identification, a military identification, or a current (within the last 12 months) utility bill, bank statement, government check, paycheck, or other government document (other than a voter registration notification mailed by a board of elections) that shows your name and current address.

 

I wish to vote in the following election to be held on

 

Check ONLY one (A separate application must be completed for each type of election):
1. Primary Election:

Constitution

Democratic

Green

Libertarian

Republican

Socialist

Nonpartisan or issues only

2. General Election

3. Special Election

I wish to have a ballot mailed to me at the address listed above. I understand that if a ballot is mailed to me and I change my mind and appear at my polling place to vote on Election Day, I will be required to vote a provisional ballot that can not be counted until at least 10 days after the election.

 

I hereby declare, under penalty of election falsification, I am a qualified voter and the statements above are true to the best of my knowledge and belief. I understand that if I do not provide the requested information, my application cannot be processed.

 

Yes, I’d like to receive email updates on the election
Yes, I’d like to receive text message updates on the election

 

 

x_______________________________________________

Signature of Voter


__________________________________

Date Signed


 

 

 

 

 

 

Voluntary: To assist the board of elections in contacting you in a timely manner if your application is incomplete:

 

Your daytime telephone number (___)__________________ Your e-mail address __________________


WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE

 

INSTRUCTIONS

Chapter 3509. of the Revised Code of Ohio

 

  1. Use of this form is optional. To be valid, your application must include your name, voting residence address, date of birth, and signature; the election for which the ballot is requested and, if a partisan primary election, your political party affiliation; statement you are a qualified elector in the county; and one of the following: your Ohio drivers license number, the last four digits of your social security number, or a copy of your current and valid photo identification, a military identification, or a current (within the last 12 months) utility bill, bank statement, government check, paycheck, or other government document (other than a voter registra tion notification mailed by a board of elections) that shows your name and address.

    2.  

  2. An application by mail must be received by your county board of elections by noon on the third day before the election. An application by you in person must be received by the close of regular board office hours the day before the election. Applications for persons who are hospitalized or for persons whose minor child is hospitalized due to an accident or unforeseeable medical emergency will be accepted until 3 p.m. on Election Day.

    3.  

  3. When you receive your ballot: If you return your ballot by mail, it must be postmarked* no later than the day before Election Day and received by your county board of elections no later than 10 days after the election. If you return your ballot in person or if a near relative delivers it to the board for you, it must be delivered to your county board of elections no later than the close of polls on Election Day. If you are a voter outside of the United States on Election Day, the ballot envelope must be signed or postmarked before the close of polls.
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  • John Kasich

    John Kasich

    Governor

    Learn More About John Kasich:

    Led the effort to balance the federal budget for the first time since man walked on the moon & now has a plan to rebuild Ohio's economy.

  • Rob Portman

    Rob Portman

    United States Senator

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    Expert on budget & trade policy who worked to reform the IRS, enforce trade laws & cut the federal deficit in half.

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    Award-winning county auditor & prosecutor with a record of rooting out government waste & corruption.

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    Mike DeWine

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    Experienced prosecutor who will fight to rebuild our economy, support law enforcement & eliminate government corruption.

  • Josh Mandel

    Josh Mandel

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    Two-term state legislator & decorated U.S. Marine Intelligence Specialist who served two tours of duty in Iraq.

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    A former legislator, current Auditor of State and one of three U.S. delegates appointed to the United Nations Commission on the Status of Women.

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