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 (877) 767-6446.

Eligibility

Registering by Mail

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

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

following requirements:

license number or the last four digits of your Social Security

number, you must enclose with your application a copy of one of the

1. You are a citizen of the United States.

following forms of 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

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

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

before the election in which you want to vote.

government check, paycheck, or government document (other

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

than a notice of voter registration mailed by a board of elections)

5. You have not been declared incompetent for voting purposes by a

that shows the voter’s name and current address.

probate court.

Residency Requirements

6. You have not been permanently disenfranchised for violations of

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

election laws.

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

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

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

registration if you have changed your address or name.

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

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

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

of a shelter or other location to which you intend to return, you may

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

use that shelter or other location as your residence for purposes

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

of registering to vote. If you have questions about your specific

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

residency circumstances, you may contact your local board of

please contact your county board of elections.

elections for further information.

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

Your Signature

both of the questions for your registration to be processed.

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

Registering in Person

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

If you have a current valid Ohio driver’s license, you must provide

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

that number on line 10. If you do not have an Ohio driver’s license,

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

you must provide the last four digits of your Social Security number

identify your signature.

on line 10. If you have neither, please write “None.”

WHOEVER COMMITS ELECTION FALSIFICATION IS

Please see information on back of this form to learn how

GUILTY OF A FELONY OF THE FIFTH DEGREE.

to obtain an absentee ballot.

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 (if necessary)

8. County (where you live)

FOR BOARD

USE ONLY

SEC4010 (Rev. 4/15)

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

election falsification I am a

Senate Dist.

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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