Please print this form out and mail it to your local board of elections

Please print this form out and mail it to your local board of elections.
Application for Absent Voter's Ballots
PLEASE TYPE OR PRINT

Applicant's Name ___________________________________	Send Ballots to (if different from home address) Name _______________________________________
Home Address ___________________________________	Care Of/PO Box _______________________________________
City, Village, or Post Office ___________________________________	Address _______________________________________
Date of Birth ____/____/________
County _______ Zip Code ________	City ____________ St __ Zip ________
I wish to vote in the following election: (check one)
1. Primary Election o Democratic o Republican o Nonpartisan or issues only o Other Party (specify) ______________________	2. o General Election 3. o Special Election Date of Election_______________
I will be absent from my polling place for the following reason: (check one)
o I am sixty-two years of age or more. o I will be absent from the county. o I or a family member will be confined in a hospital. o I am physically ill, disabled or infirmed. o (I request the assistance of two election officials.) o I am an election official or employee of the Secretary of State. o I am a full-time fire fighter, peace officer, or emergency medical service provider. o I am on active duty with the organized militia in Ohio.	o I will be confined in a jail or workhouse under sentence for a misdemeanor, or awaiting trial on a felony or misdemeanor. o I am unable to vote on election day for religious reasons. o I am confined to a public or private institution within the county. Please have two board employees deliver my ballots. o I am a former resident entitled to vote for President and Vice President.

INSTRUCTIONS

1. Application must include name, voter residence address, reason for absence from polls, applicant's signature, election for which the ballots are requested, and if primary ballots, voter's party affiliation.
2. An application by mail must be received by the Board of Elections by noon on the third day before the election. Applications by the voter in person must be received until the close of regular board hours the day before the election. Applications for persons who are hospitalized by a medical emergency will be accepted until 3 p.m. on election day.
3. Completed ballots must be delivered to the Board of Elections in person, by mail, or a near relative not later than the close of polls on election day. Exception: If the voter is outside of the United States on election day, the ballot envelope must be signed or postmarked prior to the close of polls and received by the board no later than 10 days after the election or 20 days after the presidential election.
4. If you request an absentee ballot, you will not be allowed to vote or turn in your ballot the polling place on election day.
5. This document may be reproduced.