Form 11-A - Absentee Ballot Application
Download a blank fillable Form 11-A - Absentee Ballot Application in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 11-A - Absentee Ballot Application with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Form No. 11-A Prescribed by the Secretary of State (08-17)
print clearly
Absentee Ballot Application
R.C. 3509.03
Voter Name
First
Middle
1
Required
Last
Suffix
Date of Birth
2
Date of Birth
MM/DD/YYYY
(do not write today's date here)
Required
Address at Which
County
Street Address
(no P.O. boxes)
you are Registered
3
to Vote
Required
City/Village
ZIP
Mailing Address
Street Address
(or P.O. box)
Required
only if you wish to
have your ballot mailed to a
4
different address than the
City/Village
address at which you're
registered to vote.
State
ZIP
Identification
Your Ohio driver’s license number
(2 letters followed by 6 numbers)
OR
Required
Last four digits of your Social Security number
You must provide ONE of the
OR
following.
5
Copy of a current and valid photo identification, military identification, or a current (within the
last 12 months) utility bill, bank statement, government check, paycheck or other government
document (other than a notice of voter registration mailed by a board of elections) that
contains your name and current address.
Election
Date of Election
MM/DD/YYYY
(do not write today's date here)
Required
General Election
Special Election
6
You must complete a separate
application for each election.
Primary Election
For a PARTISAN primary election only, you must choose the type of ballot:
Issues only ballot
Political party ballot Name of Political Party
Affirmation
• I wish to have an absentee ballot mailed to me at the address listed above.
Required
• I understand this request must be received by my board of elections no later than noon on the
Saturday before Election Day if by mail or by 2 p.m. the day before the election if in person.
• I understand that if an absentee ballot is mailed to me and I change my mind and go to my
polling place to vote on Election Day, I will be required to vote a provisional ballot that cannot be
counted until at least 11 days after Election Day.
• I understand that, if I do not provide the required information, my application cannot be
7
processed.
• I hereby declare, under penalty of election falsification, that I am a qualified elector and
the statements above are true.
Signature X
Today's Date
MM/DD/YYYY
To assist the board of election in contacting you in a timely manner if your application is incomplete, please provide the following information.
Telephone Number
E-mail Address
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal