Voter Registration Form
To qualify to vote, you must be:
(1) a U.S. citizen;
Please read instructions carefully.
(2) 18 years old on or before the next general election; (3) a resident of Ohio for at least 30 days immediately
before election day:
(4) registered to vote at least 30 days
before election day.
Use this form to register to vote or update a current Ohio registration if you have changed your address or name.
NOTICE: Your registration or change must be received or postmarked 30 days 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 do not receive a notice prior to election day, call your county board of elections.
Lines 1 and 2 are required by law. If you do not answer both of the questions, your registration will not be processed.
Registering in person
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 provide the last four digits of your social security number on line 10.
Registering by mail
If you register by mail and do not provide either a current Ohio driver's license number or the last four digits of your social security number, please enclose a copy of one of the following with your registration application:
• Current valid photo identification card showing your
name: or
• Current utility bill, bank statement, paycheck,
government check or government document showing
your name and address.
If you register by mail and do not provide one of the above at the time of submitting your registration application, you must provide one of the items when you vote for the first time.
Your Signature
Your registration cannot be processed without your signature. On line 14. your completed legal signature or mark should not touch surrounding lines of type. If signature is a mark, include name and address of the person who witnessed the mark beneath the signature line.
Please type or print clearly with a black pen.
FOLD HERE
1. Are you a U.S. citizen?
Yes
No
Yes
No
2. Will you be 18 years of age on or before the next general election?
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
7 Additional Rural or Mailing Address (if necessary)
8 County where you live
9 Birthdate (MO DAY YR.
10 Ohio driver's license No OR last 4 digits of Social Security No (required) 11 Phone No (voluntary)
12 ADDRESS CHANGE ONLY PREVIOUS ADDRESS Previous House Number and Street
Previous City or Post Office
13 CHANGE OF NAME ONLY
Former Legal Name
State
County
Former Signature
I declare under penalty of election falsification I am a citizen of the United States, will have lived in this state for 30 days immediately preceding the next election and I will be at least 18 years of age at the time of the general election
14
Signature of Applicant →
Date
MO
DAY
YR
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE.
6
Zip Code
FOR BOARD USE ONLY
SEC4010 (Rev 10/03)
City Village. Twp
Ward
Precinct
School Dist
Cong Dist
Senate Dist
House Dist