SAMPLE - Blank VBM Application.pdf

Returning your application

Returning your application

Yes

Month & Year Party:

Democratic

Republican

Libertarian

Issues Only

Vote-by-Mail Ballot Application

Sign Here

2. Date of birth (must be provided)

1. Name and address (must be provided)

/ / Do not write today’s date!

Month Day Year

3. Identification (must provide one of the options below)

The last four digits of your Social Security number:

Date Signed

City

E-Mail

Name

Home Address

Ohio Zip Code City

Phone

Address / P.O. Box

State

Mailing address (if different than home address):

Zip Code

• I understand that, per Ohio law, the Board of Elections must receive this request no later than the close of business seven days before Election Day.

• I understand that if an absentee ballot is mailed to me and I change my mind and go to my polling place to vote on Election Day, I will be required to vote a provisional ballot.

• I understand that if I do not provide the Board with all of the required information, my application cannot be processed.

• I hereby declare, under penalty of election falsification, that I am a qualified elector and the statements above are true.

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

OR

OR

A COPY of a different form of current photo identification (a driver license, state ID card, or interim ID form issued by the Ohio BMV; a US passport or passport card; or a US military ID card, military dependent card, Ohio National Guard ID card, or US Department of Veterans Affairs ID card). The copy of the photo ID must include images of the front and back, except for a passport which must include the passport’s identification page.

X

(no P.O. Boxes or polling place addresses)

VBM 5020_7.7.26Prescribed by the Ohio Secretary of State Form 11-A

Contact information will be used by the Board of Elections to contact you in a timely manner if your application is incomplete.

Your Ohio driver license or state ID card number:

(Begins with 2 letters and ends with 6 numbers)

Instructions

To receive a Vote-by-Mail ballot, you must complete all five sections and return this application to the

Board of Elections.

Returning your application

Your application must be received by the close of business on the seventh day before Election Day.

Please return your Vote-by-Mail application to:

Board of Elections

P.O. Box 89448

Cleveland, OH 44101-6448

You can also return your application in person to the Board of Elections located at

1803 Superior Avenue in

Cleveland, Ohio.

Complete instructions for returning your ballot are on the back of this form.

Returning your ballot

You can track the status of your

Vote-by-Mail application and ballot on our website at:

boe.cuyahogacounty.gov

Questions?

Call 216-443-VOTE (8683)

Track your ballot

Are you interested in serving as a poll worker on Election Day?

No

Call 216-443-3277 or visit boe.cuyahogacounty.gov for more info.

4. Choose election (check only one - you must complete a separate application for each election)

Primary Election November General Election

Special Election

Month & Year

5. Signature (must be provided)

Important: If selecting a partisan ballot in a primary election, the ballot will include all questions and issues which the voter is eligible to vote.

Spanish Vote-by-Mail Applications are available on our website:

boe.cuyahogacounty.gov OR call 216-443-8683

Solicitudes en español para votar por correo, disponibles en nuestro sitio web:

boe.cuyahogacounty.gov o llamando al 216-443-8683

TO VOTE IN OHIO, YOU MUST BE A CITIZEN OF THE UNITED STATES.

TO ENSURE YOUR ABSENTEE BALLOT REQUEST IS RECEIVED, PLEASE DO THE FOLLOWING:

Ensure that all fields are complete.

If requesting a ballot for a primary election, and you wish to vote in a party’s primary election, make sure you have checked your desired party. If you do not wish to affiliate with a party or to vote in their primary, choose “Issues Only.”

Sign and date your form.

Mail the completed form to:

This form MUST be received by the close of business on the seventh day before Election Day.

If you have additional questions, please call the office of the Cuyahoga County Board of Elections at 216-443-8683

Once your board of elections receives your absentee ballot request, the board will process your request and mail your ballot to your address.

Ohio law requires all absentee ballots to be received by 7:30 p.m. on Election Day under one of the following options:

BY MAIL: Complete your ballot, insert it into the return envelope, and return it with affixed postage to your county board of elections as soon as possible to allow for postal delivery by 7:30 p.m. on

Election Day.

IN PERSON TO A DROP BOX: Complete your ballot, insert it into the return envelope, and return it in person without postage to the drop box located at your county board of elections by 7:30 p.m. on

Election Day.

IN PERSON AT THE BOARD OF ELECTIONS OFFICE: Complete your ballot, insert it into the return envelope, and return it in person without postage to your county board of elections office by 7:30 p.m.

on Election Day. Only you or a near relative* may deliver your ballot. A voter who is disabled may select anyone to deliver their ballot, other than their employer or an officer in their union. The person delivering a ballot for either a family member or a voter with a disability MUST complete an attestation form at the county board of elections office (Form 12-P). For county boards of elections locations and hours, please visit VoteOhio.gov/Boards.

If you are a member of the uniformed services or a voter outside of the United States, ballots must be received by the fourth day after the election. Sign your identification envelope by the close of polls on Election Day or return it in person by 7:30 p.m. on Election Day.

You must complete this form yourself unless you are unable to do so due to disability, illiteracy, or blindness.

*Near relative includes the voter’s spouse or the voter’s father, mother, father-in-law, mother-in-law, grandfather, grandmother, brother, or sister of the whole or half blood, or the son, daughter, adopting parent, adopted child, stepparent, stepchild, uncle, aunt, nephew, or niece (R.C. 3509.05).

TO ENSURE YOUR ABSENTEE BALLOT REQUEST IS RECEIVED, PLEASE DO THE FOLLOWING:

Cuyahoga County Board of Elections, P.O. Box 89448, Cleveland, Ohio 44101-6448

OR

Return the completed form in person:

Cuyahoga County Board of Elections, 1803 Superior Avenue, Cleveland, Ohio 44114

NEXT STEPS:

Track Your Ballot: You can track your request and your ballot online at boe.cuyahogacounty.gov

How to Return Your Absentee Ballot:

A COPY of a different form of current photo identification (a driver license, state ID card, or interim ID form issued by the Ohio BMV; a US passport or passport card; or a US military ID card, military dependent card, Ohio National Guard ID card, or US Department of Veterans Affairs ID card). The copy of the photo ID must include images of the front and back, except for a passport which must include the passport’s identification page.

You must complete this form yourself unless you are unable to do so due to disability, illiteracy, or blindness.