Application for Absentee Ballot
Name ____________________
Address____________________
City and State_______________
County Athens
Zip code___________________
Phone Number________________
Email_______________________
If you want the ballot mailed to an address different than the one where you are registered to vote fill this section out.
Board of Elections Please mail to a different address which is as follows.
Address___________________________
City and State______________________
Zip code__________________________
I request that an absentee ballot be issued to me for the November 4, 2008 General Election.
My birth date is _____________.
The last four digits of my social security number are______________or my Ohio Driver's License Number is _________________. (you only need to give one or the other) Note be sure to use the number on the left hand side of your license not the camera number over your picture.
I hereby declare, that I am a qualified voter and that the statements above are true to the best of my knowledge and belief.
Signed X_____________________ Dated: ___________.
( This must be signed not printed)
Mail to the Athens County Board of Elections at P.O. Box 609, Athens, Ohio 45701.
Print this out and complete