Form No. 11-A Prescribed by the Secretary of State (08-17)
Absentee Ballot Application
print clearly
R.C. 3509.03
Voter Name
Required
1
First Middle
Last Suffix
Date of Birth
Required
2
Date of Birth (do not write today's date here)
Address at Which
you are Registered
to Vote
Required
3
Street Address (no P.O. boxes)
County
City/Village
ZIP
Mailing Address
Required only if you wish to
have your ballot mailed to a
different address than the
address at which you're
registered to vote.
4
Street Address (or P.O. box)
City/Village
State
ZIP
Identification
Required
You must provide ONE of the
following.
5
Your Ohio driver’s license number (2 letters followed by 6 numbers)
OR
Last four digits of your Social Security number
OR
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
Required
You must complete a separate
application for each election.
6
Date of Election (do not write today's date here)
General Election
Primary Election
Special Election
For a PARTISAN primary election only, you must choose the type of ballot:
Political party ballot
Name of Political Party
Issues only ballot
Affirmation
Required
7
I wish to have an absentee ballot mailed to me at the address listed above.
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
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
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.
If you have additional questions, please call the office of the Ohio
Secretary of State at (877) SOS-OHIO (877-767-6446).
For your county board's address please visit
VoteOhio.gov/boards
1. Make sure you have filled in the type of ballot you are requesting. For the 2020
primary, the choices are Republican, Democrat, Libertarian, or Issues Only
(section 6)
2. Ensure “Date of Election” (section 6) lists the date of the election for which you are
requesting a ballot, NOT today’s date.
3. Check that all required fields are complete.
4. Print, sign, and date your form.
5. Mail the completed form to your county board of elections.
TO ENSURE YOUR ABSENTEE BALLOT REQUEST IS RECEIVED,
PLEASE DO THE FOLLOWING:
Once your absentee ballot request is received by your county board of elections, they
will process your request and mail your ballot to your address. The boards of elections
will prepay return postage.
Once you receive your ballot, to make sure your ballot is counted, it must be received
by your board of elections by 7:30 p.m. on April 28 OR be postmarked by April 27 and
delivered by mail to your board of elections by May 8.
The U.S. Postal Service (USPS) estimates that it may take two to five days for your
voted absentee ballot to be delivered to your board of elections by mail.
You can track your request and your ballot online at VoteOhio.gov.
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