Form 11-A Prescribed by the Ohio Secretary of State (7/2020)
please print clearlyR.C. 3509.03
Absentee Ballot Application
Email:Telephone Number:
2) Your contact information
(recommended)
Contact information will be used by the board of elections to contact you in a timely manner if your application is incomplete.
Suffix:
Last:
Middle:
First:
1) Your name
3) Your date of birth:
ZIP:State:County:City:
Street Address:
4) Your home address at which you are registered to vote
(no P.O. Boxes or polling place addresses)
Today's Date:
Signature X
8) AffirmationI understand that, per Ohio law, the board of elections must receive this request no later than noon on the
Saturday before Election Day. To account for possible delivery delay, return the application to the board of elections at least seven
days before the election.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.I understand that if I do not provide the board with all of the
required information, my application cannot be processed.I hereby declare, under penalty of election falsification, that I am a
qualified elector and the statements above are true.
Important: If selecting a partisan ballot in a primary election, the ballot will include all questions and issues which the voter is eligible to vote.
Democratic Libertarian Republican Issues Only
If a primary election is selected, indicate the type of ballot you would like to receive by selecting ONE of the following:
Date:
Date:
November General Election
Special Election
Primary Election
7) Election in which you would like to vote
(you must complete a separate application for each election)
C. A 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 shows your name and current address.
B. Write in your Ohio driver license number
(2 letters followed by 6 numbers):
A. Write in the last four digits of your Social Security number:
6) Your identification
Provide ONE of the following:
ZIP:State:City:
Street Address (or P.O. Box):
5) The address where you receive mail
(if different than above)
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE.
9) I am interested in serving as a poll worker on Election Day. (optional)
NoYes
Lorain County Board of Elections
1985 N. Ridge Rd. East
Lorain, OH 44055
click to sign
signature
click to edit
Once your board of elections receives your absentee ballot request, the board will process
your request and mail your ballot to your address.You can track your request and your
ballot online at VoteOhio.gov/track.If you return your absentee 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. By state law, a postmark does not
include a date marked by a postage evidence system such as a postage meter.If you return
your ballot to the board in person, or if a near relative* delivers it for you, the board of
elections must receive your ballot no later than 7:30 p.m. on Election Day. If you are a
member of the uniformed services or a voter outside of the United States, the ballot must
be mailed not later than 12:01 a.m. on Election Day at the place where you are located.
*Near relative includes the voter’s spouse or the voter’s father, mother, father-in-law, mother-in-law, grandfather, grandmother,
brother, or sister of the whole or half blood, or the son, daughter, adopting parent, adopted child, stepparent, stepchild, uncle, aunt,
nephew, or niece.
Ensure that all fields are complete.If requesting a ballot for a primary election, and you
wish to vote in a party’s primary election, make sure you have checked your desired party.
If you do not wish to affiliate with a party or to vote in their primary, choose “Issues
Only.”Sign and date your form.Mail the completed form to your county board of elections,
or return the completed form to your county board of elections office.For your county’s
board of elections address, please visit VoteOhio.gov/boardsIf you have additional
questions, please call the office of the Ohio Secretary of State at (877) SOS.OHIO
(877.767.6446).
TO ENSURE YOUR ABSENTEE BALLOT REQUEST IS RECEIVED, PLEASE DO THE FOLLOWING:
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