Fillable Printable Ohio Voter Registration Information Update Form
Fillable Printable Ohio Voter Registration Information Update Form
Ohio Voter Registration Information Update Form
Ohio driv er’s license No. OR
last 4 digits of Social Security No.
(one form of ID required to be listed or provided)
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:
www.OhioSecretaryofState.gov
or call
1-877-767-6446.
Eligibility
You are qualified to register to vote in Ohio if you meet all the
following requirements:
1. You are a citize n o f the U nite d States.
2. You will be at least 18 years old on or before the day of
the gene ral election.
3. You will be a resident of Ohio for at l east 30 days
immed i ately be fore the election in which you want to vote.
4. You are not incarcerated (in jail or in prison) fo r a felony
conviction.
5. You have not been declared incompetent for voting
purposes by a probate court.
6. You have not been permanently disenfranchised for
violations of election laws.
Use this form to register to vote or to update your current Ohio
registration if you have changed your address or name.
NOTICE: This form must be received or postmarked by the 30 th day
before an election at which you intend to vote. You w ill be notified by
your county board of elections of the location where you vote. If you
do not receive a notice following timely submission of this form, please
contact your county board of elections.
Numbers 1 and 2 below are required by law. You must answer both
of the questions for your registration to be p rocessed.
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 Socia l Se curity number on line 10. If
you have neither, please write “None.”
Registering by Mail
If you register by mail and do not provide either an Ohio driver’s license
number or the last four digits of your Social Security number, you must
enclose with your application a copy of one of the following forms of
identification:
Current and valid photo identification, a military identific ation , or
a current (within the last 12 m onths) utility bill, bank statement,
paycheck, government check or government document (other
than a notice of voter registration mailed by a board of
elections) that shows your name and current address.
Residency Requirements
Your voting residence is the location that you consider to be a
permanent, not a temporary, residence. Your voting resid e nce is the
place in which your habitation is fixed and to which, whenever 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 of a s he lte r or
other location to which you intend to return, you may use that shelter
or other loca tion as your residence for purposes of registering to vote.
If you have questions about your specific residency circumstances, you
may contact your local board of elections for further information.
Your Signature
In the area below the arrow in Box 14, please write your cursive,
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
your county board of elections it can effectively be used to id e ntify your
signature.
Please see information on back of this form to learn how
to
obtain an absentee
ballot.
WHOEVER COMMITS ELECTION FALSIFICATION IS
GUILTY OF A FELONY OF THE FIFTH DEGREE.
I am:
FOLD HERE
Registering as an Ohio voter
Updating my address
Updating my name
1. Are y ou a U.S. citizen? Yes No
2. Will you be at least 18 years of age on or before the next general election? Yes No
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 a ddress if changed) Apt. or Lot # 5. City o r Post Office 6. ZIP Code
7. Additional Mailing Address or P.O. Box (if necessary) 8. County (where you live)
FOR BOARD
USE ON L
Y
SEC4010 (Rev. 6/14)
9. Birth dat e ( MO-DAY-YR) (required) 10. Ohio Driver’s License No. OR
Last Four Digits of Social Security no.
(one form of ID required to be listed or provided)
12. PREVIOUS ADDRESS IF UPDATING CURRENT REGISTRATION - Previous House Number and Street
11. Phone No. (voluntary)
City, Village,
T
wp.
W
ard
Previous City or Post Office County State
13. CHANGE OF NAME ONLY Former Legal Name Former Signature
Precinct
School Dist.
14.
I declare under penalty of
election falsifi cation I am a
citizen of the U nited States, will
have lived in this state for 30
days immediately preceding
the next election, and w ill be
at least 18 years of age at the
Your
Signature
Date
/
/
MO DAY YR
Cong. Dist.
Senate Dist.
House Dist.
time
of
the general el ection.
To ensure your information is updated, please do the following:
1. Print this form.
2. Co m plete all required fields.
3. Sign and date your form.
4. Fold and i nsert your form into an envelope.
5. Mail your form to your county board of elections. For your county board’s
address please visit www.OhioSecretaryofState.gov/boards.htm.
If you have addit ional questions, pl ease call the offic e of t he Ohio Secretary of State
at 877-SOS-OHIO (767-6446).
HOW TO OBTAIN AN OHIO ABSENTEE BALLOT
You are entitled to vote by absentee ballot in Ohio without providing a reason. Ab sentee ballot applications may
be obtained from your county board of elect ions or from the Secretary of State at:
www.OhioSecretaryofState.gov or by ca lling 1-877-767-6446.
OHIO VOTER IDENTIFICATION REQUIREMENTS
Voters must br ing identification to the polls in order to ver ify identity. Identificat ion may include current and valid
photo identification, a militar y ide ntification, or a copy of a curre nt (within the las t 12 months) utility bill, bank
sta tement, government check, paycheck, or other government docume nt, other than a notice o f an election or a
voter registration notification sent b y a board of elections, that shows the voter’s name and current address.
Voters who do not provi de one of these documents will still be able to vote by providing the last fo ur digits of the
voter’s Social Security numbe r and by cast ing a pr ovisi onal ballot pursuant to R.C. 3505.181. For more information
on voter identifi cation requirements, please consult the Secretary of State’s website
at:www.OhioSecretaryofState.gov or call 1-877-767-6446.
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY
OF A FELONY OF THE FIFTH DEGREE.
