Fillable Voter Registration And Information Update Form printable pdf download

Voter Registration and Information Update 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 website at: or call 1-877-767-6446.

Eligibility

Registering by Mail

If you register by mail and do not provide either an Ohio driver’s license

You are qualified to register to vote in Ohio if you meet all the

number or the last four digits of your Social Security number, you must

following requirements:

enclose with your application a copy of one of the following forms of

1. You are a citizen of the United States.

identification:

2. You will be at least 18 years old on or before the day of

the general election.

Current and valid photo identification, a military identification, or

a current (within the last 12 months) utility bill, bank statement,

3. You will be a resident of Ohio for at least 30 days

paycheck, government check or government document (other

immediately before the election in which you want to vote.

than a notice of voter registration mailed by a board of

4. You are not incarcerated (in jail or in prison) for a felony

elections) that shows your name and current address.

conviction.

5. You have not been declared incompetent for voting

Residency Requirements

purposes by a probate court.

Your voting residence is the location that you consider to be a

permanent, not a temporary, residence. Your voting residence is the

6. You have not been permanently disenfranchised for

place in which your habitation is fixed and to which, whenever you

violations of election laws.

are absent, you intend to return. If you do not have a fixed place of

habitation, but you are a consistent or regular inhabitant of a shelter or

Use this form to register to vote or to update your current Ohio

other location to which you intend to return, you may use that shelter

registration if you have changed your address or name.

or other location as your residence for purposes of registering to vote.

If you have questions about your specific residency circumstances, you

NOTICE:

This form must be received or postmarked by the 30th day

may contact your local board of elections for further information.

before an election at which you intend to vote. You will be notified by

your county board of elections of the location where you vote. If you

Your Signature

do not receive a notice following timely submission of this form, please

In the area below the arrow in Box 14, please write your cursive,

contact your county board of elections.

hand-written signature or make your legal mark, taking care that it

does not touch the surrounding lines so when it is digitally imaged by

Numbers 1 and 2 below are required by law. You must answer both

your county board of elections it can effectively be used to identify your

of the questions for your registration to be processed.

signature.

Please see information on back of this form to learn how to

Registering in Person

obtain an absentee ballot.

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 driver’s license, you must

WHOEVER COMMITS ELECTION FALSIFICATION IS

provide the last four digits of your Social Security number on line 10. If

you have neither, please write “None.”

GUILTY OF A FELONY OF THE FIFTH DEGREE.

FOLD HERE

I am:

Registering as an Ohio voter

Updating my name

Updating my address

1. Are you a U.S. citizen?

Yes

2. Will you be at least 18 years of age on or before the next general election?

Yes

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 Office

6. ZIP Code

7. Additional Mailing Address or P.O. Box (if necessary)

8. County (where you live)

FOR BOARD

USE ONLY

SEC4010 (Rev. 6/14)

9. Birthdate (MO-DAY-YR) (required) 10. Ohio Driver’s License No. OR

Ohio driver’s license No. OR

11. Phone No. (voluntary)

City, Village, Twp.

Last Four Digits of Social Security no.

last 4 digits of Social Security No.

(one form of ID required to be listed or provided)

Ward

12. PREVIOUS ADDRESS IF UPDATING CURRENT REGISTRATION - Previous House Number and Street

Precinct

Previous City or Post Office

County

State

School Dist.

13. CHANGE OF NAME ONLY Former Legal Name

Former Signature

Cong. Dist.

14.

Date

Your Signature

I declare under penalty of

DAY

Senate Dist.

election falsification I am a

citizen of the United States, will

have lived in this state for 30

House Dist.

days immediately preceding

the next election, and will be

at least 18 years of age at the

time of the general election.

Voter Registration And Information Update Form

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