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Ohio Voter Registration Form

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Ohio Voter Registration Form
Ohio Voter Registration Form
Voter Registration Form
Please read instructions carefully. Please type or print clearly with blue or black ink.
For further information, you may consult the Secretary of State’s Web site at: www.sos.state.oh.us or call 1-877-767-6446.
Eligibility
You are qualied to register to vote in Ohio if you meet all
the following requirements:
1. You are a citizen of the United States.
2. You will be at least 18 years old on or before the day of
the general election.
3. You will be a resident of Ohio for at least 30 days
immediately before the election in which you want to
vote.
4. You are not incarcerated (in jail or in prison) for a felony
conviction.
5. You have not been declared incompetent for voting
purposes by a probate court.
6. You have not been permanently disenfranchised for
violations of the election laws.
Use this form to register to vote or to update your current Ohio
registration if you have changed your address or name.
NOTICE: This form must be
received or postmarked
by the 30th day
before an election at which you intend to vote. You will be notied
by your county board of elections of the location where you vote. If
you do not receive a notice prior to Election Day, please contact your
county board of elections.
Lines 1 and 2 below are required by law. You
must
answer
both
of the questions for your registration to be processed.
Registering in Person
If you have a current valid Ohio driver’s license, you must provide
that number on line 10. If you do not have an Ohio drivers license,
you must provide the
last four digits
of your Social Security number
on line 10. If you have neither, please write “None.
Registering by Mail
If you register by mail and do not provide either a current Ohio
driver’s license number or the last four digits of your Social Security
number, please enclose with your application a copy of one of the
following forms of identication that shows your name and current
address:
Current valid photo identication card, military identication,
current (within one year) utility bill, bank statement, paycheck,
government check or government document (except board of
elections notications) showing your name and current address.
Your Signature
Your signature is required for your registration to be processed. In
the box next to the arrow by line 14, please afx your signature or
mark, taking care that it does not touch surrounding lines or type so
it can be effectively used to identify you. If your signature is a mark,
include the name and address of the person who witnessed the
mark beneath the signature line. If by reason of disability you are
unable to physically sign, you may follow specic procedures found
in Ohio law (R.C. 3501.382) to appoint an attorney-in-fact who may
sign this form on your behalf at your direction and in your presence.
Please see information on back of this form to learn how to
obtain an absentee ballot.
FOLD HERE
1. Are you a U.S. citizen Yes No
2. Will you be at least 18 years of age on or before the next general election Yes No
If you answered NO to either of the questions, do not complete this form.
3. Last Name
First Name Middle Name or Initial Jr., II, etc.
4. House Number and Street (Enter new address if changed)
Apt. or Lot # 5. City or Post Ofce 6. ZIP Code
7. Additional Rural or Mailing Address (if necessary) 8. County where you live
9. Birthdate (MO-DAY-YR) (required) 10. Ohio driver’s license No. OR 11. Phone No. (voluntary)
last 4 digits of Social Security No.
12. PREVIOUS ADDRESS IF UPDATING CURRENT REGISTRATION - Previous House Number and Street
Previous City or Post Ofce
County State
13. CHANGE OF NAME ONLY Former Legal Name Former Signature
I declare under penalty of election falsication I am a citizen of the United States, will have lived in this state for 30
days immediately preceding the next election, and will be at least 18 years of age at the time of the general election.
14. Your Signature
Date_______/_______/_______
MO DAY YR
FOR BOARD
USE ONLY
SEC4010 (Rev. 02/08)
City, Village, Twp.
Ward
Precinct
School Dist.
Cong. Dist.
Senate Dist.
House Dist.
(one form of ID required to be listed or provided)
Reset Form
Ohio Voter Registration Form
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