Each individual who casts a provisional ballot under section 3505.181 of the Revised Code shall
execute a written affirmation. The form of the written affirmation shall be printed upon the face of
the provisional ballot envelope and shall be as follows:
"Provisional Ballot Affirmation
(A) Clearly print your full name: ___________________
(B) Write your date of birth: _______________________
(C)(1) Write your current address: __________________
_____________________________________________________
(2) Have you moved without updating your voter registration?:
Yes ______ No ______
If yes, write your former address: __________________
_____________________________________________________
Failure to provide your former address will not cause your provisional ballot to be rejected.
(D)(1) You must show photo identification to the election official that includes your name and
photograph and is not expired. Check the type of photo identification you provided:
______ An Ohio driver's license or state identification card or an interim identification form issued
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by the Bureau of Motor Vehicles. If you showed your Ohio driver's license or state identification
card or an interim identification form, write your full driver's license or state identification card
number: ________________________
______ A United States passport or passport card;
______ A United States military identification card, Ohio national guard identification card, or
United States department of veterans affairs identification card.
(2) If you do not have photo identification because you have a religious objection to being
photographed, complete an affidavit of religious objection. The precinct election official will attach
it to the provisional ballot envelope.
(3) If you did not show photo identification to the election official or complete an affidavit of
religious objection, you must appear at the office of the board of elections during the four days after
the election and provide photo identification or complete an affidavit of religious objection for your
vote to be eligible to be counted.
(4) Complete this section if you need to update your voter registration or if you need to verify the
identification you used to register to vote. If you need to verify your identification and you do not
provide the needed information on this form, you must provide the information to the board of
elections on or before the fourth day following this election in order for your ballot to be eligible to
be counted.
Write your full Ohio driver's license or state identification card number:
________________________
Write the last four digits of your Social Security number: _______________
(5) If you are casting a provisional ballot because you need to provide proof of citizenship, you must
do one of the following for your ballot to be eligible to be counted:
(a) If you have already provided proof of citizenship to the Bureau of Motor Vehicles, write your full
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Ohio driver's license or state identification card number above.
(b) Provide proof of citizenship to the board of elections on or before the fourth day following this
election.
(E) If your right to vote has been challenged, you must provide any required additional information
to the board of elections on or before the fourth day following this election.
(F) Sign and date the following statement:
I solemnly swear or affirm that I am a citizen of the United States; that I will be at least 18 years of
age at the time of the general election; that I have lived in this state for 30 days immediately
preceding this election in which I am voting this ballot; that I am a registered voter in the precinct in
which I am voting this provisional ballot; and that I am eligible to vote in the election in which I am
voting this provisional ballot.
I understand that, if the information I provide on this provisional ballot affirmation is not fully
completed and correct, if the board of elections determines that I am not registered to vote, a resident
of this precinct, or eligible to vote in this election, or if the board of elections determines that I have
already voted in this election, my provisional ballot will not be counted. I understand that, if I am not
currently registered to vote or if I am not registered at my current address or under my current name,
this form will serve as an application to register to vote or update my registration for future elections,
as long as I provide all of the information required to register to vote or update my registration. I
further understand that knowingly providing false information is a violation of law and subjects me
to possible criminal prosecution.
I hereby declare, under penalty of election falsification, that the above statements are true and correct
to the best of my knowledge and belief.
________________________
Signature of Voter
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________________________
Date
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE
FIFTH DEGREE."
In the case of an individual who is casting a provisional ballot because the individual needs to
provide proof of citizenship, the election officials shall provide the individual with a copy of a list of
the documents that qualify as proof of citizenship.
In addition to any information required to be included on the written affirmation, an individual
casting a provisional ballot may provide additional information to the election official to assist the
board of elections in determining the individual's eligibility to vote in that election, including the
date and location at which the individual registered to vote, if known.
If the individual provided all of the information required under section 3503.14 of the Revised Code
to register to vote or to update the individual's registration on the provisional ballot affirmation, the
board of elections shall consider the individual's provisional ballot affirmation to also serve as a
notice of change of name, change of residence, or both, or as a voter registration form, as applicable,
for that individual only for the purposes of future elections.
Page 4§ 3505.182Provisional ballot affirmation - verification
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Primary source. The text above is the canonical statute body as it appears in this revision of the atlas. Verify against the official gazette before quoting in litigation or formal advice. Spot an error? Suggest a correction.