Form No. 11-E Prescribed by the Secretary of State (08-17)
Application by Relative for Uniformed Services
or Overseas Absent Voter's Ballot
R.C. 3511.02(C)
print clearly
This completed form must be delivered in person or by mail to the board of elections. It may not be e-mailed or faxed.
Voter Name
Required
1
First Middle
Last Suffix
Voter Date of Birth
Required
2
Date of Birth (Do not write today's date here)
Address at Which
Voter is
Registered to Vote
Required
3
Street Address (No P.O. Boxes)
County
City/Village
ZIP
Length of time voter, or parent or legal guardian, has resided at this address
immediately before commencing service or departing U.S.
Voter Identification
Required
You must provide ONE of the
following.
4
OR
Your Ohio driver’s license number (2 letters followed by 6 numbers)
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.
5
Date of Election (Do not write today's date here)
General Election
Special Election
Primary Election
For a PARTISAN primary election only, you must choose the type of ballot:
Political party ballot
Name of Political Party
Issues only ballot
Please Deliver the
Ballot as Follows
Required
Select only ONE.
6
Mail the ballot to:
Fax the ballot to: (area code and fax number)
E-mail the ballot to:
Requestor
Information
Required
* "Family member" means the
voter's: spouse, father, mother,
father-in-law, mother-in-law,
grandfather, grandmother, brother,
sister, son, daughter, stepparent,
stepchild, uncle, aunt, nephew or
niece.
7
I am requesting this ballot on behalf of a qualified voter who is:
a uniformed services voter, OR
an overseas voter.
Name of family member
Relationship to Voter*
Street Address (No P.O. Boxes)
County
City/Village
ZIP
Affirmation
Required
8
Signature of Relative X
Today's Date
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE.
• The uniformed serviced or overseas voter wishes to have an absentee ballot mailed to him/her at the address
listed above.
• I and the uniformed serviced or overseas voter understand this request must be received by the board of elections no
later than noon on the Saturday before Election Day.
• The voter understands that if an absentee ballot is mailed to him/her and he/she changes his/her mind and goes to the
polling place to vote on Election Day, he/she 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, this application cannot be processed.
• I hereby declare, under penalty of election falsification, that the voter is a qualified elector and the statements
above are true to the best of my knowledge and belief.
