STATE OF OHIO
MONTGOMERY COUNTY BOARD OF ELECTIONS
ABSENTEE BALLOT APPLICATION FORM

GENERAL INSTRUCTIONS AND INFORMATION

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 3 p.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 delivered to your county board of elections no later than the close of polls on Election Day. If you are a voter outside of 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.

This document may be reproduced.

Once you have submitted your information, your ABSENTEE BALLOT APPLICATION form will appear on your screen. Print your application form.

DO NOT FORGET TO SIGN AND DATE YOUR ABSENTEE BALLOT APPLICATION FORM BEFORE MAILING IT TO THE BOARD OF ELECTIONS.

Please mail to:
Montgomery County Board of Elections
Absentee Ballot Department
P.O. Box 8705
Dayton, Ohio 45481-8705

Please read the entire form before you complete it.

Voter's Name:
Home Address:
City, Village, or Post Office:
County:
Zip code:
Mail Ballot To (if different from home address):
Name/Care of:
P.O. Box:
Address:
City:
State:
Zip code:
You MUST provide your birthdate: (enter MM/DD/YYYY) and one of the following:
Your OHIO driver's license number: , or
The last 4 digits of your social security number: , or
Copy of a 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 current address.
Voluntary: To assist the board of elections in contacting you in a timely manner if your application is incomplete:
Your daytime telephone number: Your e-mail address:

I wish to vote in the following election:

	Primary Election: July 13, 2010 Party: Constitution Democratic Green Libertarian Republican Socialist Nonpartisan or Issues Only		Special Election: July 20, 2010		Special Election: August 3, 2010		General Election: November 2, 2010

DO NOT FORGET TO SIGN AND DATE YOUR ABSENTEE BALLOT APPLICATION FORM BEFORE MAILING IT TO THE BOARD OF ELECTIONS.

PLEASE CLICK ON THE "PREVIEW ABSENTEE FORM AND PRINT" BUTTON TO VIEW THE FORM. THEN USE YOUR PRINT FUNCTION IN ORDER TO PRINT THE FORM THAT WILL BE MAILED TO THE MONTGOMERY COUNTY BOARD OF ELECTIONS.

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