1. Are you 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.
FOR BOARD
USE ONLY
SEC4010 (Rev. 1/08)
EFS
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.
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 6. Zip Code
7. Additional Rural or Mailing Address (if necessary) 8. County where you live
12. PREVIOUS ADDRESS IF UPDATING CURRENT REGISTRATION - Previous House Number and Street
Previous City or Post Office County State
13. CHANGE OF NAME ONLY Former Legal Name Former Signature
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Eligibility
You are qualified to register to vote in Ohio if you meet all
the following requirements:
1. You are a citizen of the United States.
2. You will be at least 18 years old on or before the day of
the general election.
3. You will be a resident of Ohio for at least 30 days im-
mediately before the election in which you want to vote.
4. You are not incarcerated (in jail or prison) for 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 the election laws.
Use this form to register to vote or update your current
Ohio registration if you have changed your address or
name.
NOTICE: Your registration or change must be UHFHLYHG or
SRVWPDUNHG by the 30th day 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, please contact your
county board of elections.
Lines 1 and 2 are required by law. You PXVW answer both
of the questions or your registration cannot be processed.
Mandatory Fields
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 ODVWIRXUGLJLWV of your Social Security number
on line 10. If you have neither, please write “None.”
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
forms of identification with your registration application:
• Current valid photo identification card, military identification,
current utility bill, bank statement, paycheck, government check
or government document (except board of elections notifications)
showing your name and current address.
Your Signature
Your registration cannot be processed without your signature. On
line 14, please affix your signature or mark taking care that it does
not touch surrounding lines or type so it can be effectively used to
verify your identity. If your signature is a mark, include the name
and address of the person who witnessed the mark beneath the
signature line. If by reason of disability you are unable to
physically sign, you may follow specific procedures found in Ohio
law (R.C. 3501.382) to appoint an attorney-in-fact who may sign
this form on your behalf at your direction and in your presence.
Please see voter identification requirements for voting and
absentee ballot information on back.
Voter Registration 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 Web site at: www.sos.state.oh.us or call 1-877-767-6446.
9. Birthdate (MO-DAY-YR) (required) 11. Phone No. (voluntary)
10. Ohio driver’s license No. OR
last 4 digits of Social Security No.
(required to be listed if you have one)
14. Your Signature
Date ______/______/______
MO DAY YR
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