Text Box: For Office Use             _________________             _________________             _________________

 

  Please return application to:                                                                                                                                                          

Ashland Co. Board of Elections                  Application for Absent Voter’s Ballots            

110 Cottage St., Ashland, Oh  44805                             PLEASE PRINT OR TYPE         

419-282-4273                                                         (See Instructions at bottom of page)                                                      

 

                                                                                                                                                                            Send Ballot to:

                                                                                                                                                (If different from home address)

 

______________________________________________________                    ____________________________________________________

 Voter’s First Name / Middle Initial / Last Name / Sr/ Jr                                Name

 

________________________________________________                                ______________________________________________

 Home Address in Ashland County                                                                    In Care of (if different than voter address)

 

________________________________________________                                ______________________________________________

City or Village                                      Zip Code                                                                Address

 

________________________________________________                                ______________________________________________

Telephone Number/E-mail Address                                                                   City of Village                   State              Zip Code

               

  You must provide your birthdate: ________/_________/________ and    one of the following:

                                                                                                month                 date                 year

·         Your Ohio driver’s license number_________________________________,or

·         The last four digits of your social security number____________________________,or

·         COPY of a current and valid photo identification, military identification, current (within the last 12 months)

         utility bill, bank statement, government check, paycheck or other government document (other than a voter

         registration notification mailed by a Board of Elections) that shows your name and current address.

 

               I wish to vote in the following election to be held on ___________________________________________

                                                                                                                                              (Date of Election)

                Check one:

1.        Primary Election                                                           2. _____General Election

_____Democratic & Issues

_____Republican & Issues

_____Non-Partisan and/or Issues Only                  3 ._____Special Election

I wish to have a ballot mailed to me at the address listed above.  I understand that if a ballot is mailed to me and I change

my mind and appear at my polling place to vote on Election Day, I will be required to vote a provisional ballot that can not be counted until at least 10 days after the election. I hereby declare, under penalty of election falsification, I am a qualified voter and the statements above are true to the best of my knowledge and belief.  I understand that if I do not provide the requested information, my application cannot be processed.

 

                X______________________________________________                  _____________________________

                                SIGNATURE OF VOTER                                                                  DATE SIGNED

             WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE

Text Box:   INSTRUCTIONS Chapter 3509 of the Revised Code of Ohio 1.        Use of this form is optional.  To be valid, your application must include your name, voting residence address, date of birth, and signature; the election for which the ballot is requested and, if a partisan primary election, your political party affiliation; statement you are a qualified elector in the county; and one of the following: your Ohio drivers license number, the last four digits of your social security number, or a copy of your current and valid photo identification, a military identification, or a current (within the last 12 months) utility bill, bank statement,  government check, paycheck or other government document (other than a voter registration notification mailed by a Board of Elections) that shows your name and address. 2.        An application by mail must be received by your county board of elections by noon on the third day before the election. An application by you in person must be received by the close of regular board office hours the day before the election. Applications for persons who are hospitalized or for persons whose minor child is hospitalized due to an accident or unforeseeable medical emergency will be accepted until 3p.m. on Election Day. 3.        When you receive your ballot:  If you return your ballot by mail, it must be postmarked* no later than the day before Election Day and received by your county board of elections no later than 10 days after the election.  If you return your ballot in person or if a near relative delivers it to the board for you, it must be delivered to your county board of elections no later than the close of polls on Election Day.  If you are a voter outside the United States on Election Day, the ballot envelope must be signed or postmarked before the close of polls and received by the board no later than 10 days after Election Day or 20 days after a presidential primary election.         *Postmarked does not include a date marked by a postage evidence system such as a postage meter.                                                   Ashland County Board of Elections Website:  www.ashlandboe.com