Ohio Rev. Code § 3509.04
Identification Envelope Statement of Voter
I, ________________________(Name of voter), declare under penalty of election falsification that the within ballot or ballots contained no voting marks of any kind when I received them, and I caused the ballot or ballots to be marked, enclosed in the identification envelope, and sealed in that envelope.
My voting residence in Ohio is
________________________________________________________________
(Street and Number, if any, or Rural Route and Number)
of ________________________________ (City, Village, or Township) Ohio, which is in Ward _____________ Precinct ________________ in that city, village, or township.
If I have a confidential voter registration record, I am providing my program participant identification number instead of my residence address: ________________________
The primary election ballots, if any, within this envelope are primary election ballots of the _____________ Party.
Ballots contained within this envelope are to be voted at the __________ (general, special, or primary) election to be held on the __________________________ day of ______________________, ____.
My date of birth is _______________ (Month and Day), __________ (Year).
(Voter must provide one of the following:)
My Ohio driver's license or state identification card number is _______________ (Driver's license or state identification card number).
The last four digits of my Social Security Number are _______________ (Last four digits of Social Security Number).
______ In lieu of providing a driver's license or state identification card number or the last four digits of my Social Security Number, I am enclosing a copy of my photo identificationin the return envelope in which this identification envelope will be mailed.
I hereby declare, under penalty of election falsification, that the statements above are true, as I verily believe.
_________________________
(Signature of Voter)
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE.
The board shall mail with the ballots and the unsealed identification envelope an unsealed return envelope upon the face of which shall be printed the post-office address of theboard. In the upper left corner on the face of the return envelope, several blank lines shall be printed upon which the voter may write the voter's name and return address. The return envelope shall be of such size that the identification envelope can be conveniently placed within it for returning the identification envelope to theboard.
No public office, and no public official or employee who is acting in an official capacity, shall prepay the return postage for any absent voter's ballots.
Except as otherwise provided in this section and in sections 3505.24 and 3509.08 of the Revised Code, an election official shall not fill out any portion of an identification envelope statement of voter or an absent voter's ballot on behalf of an elector. A board of elections may preprint only an elector's name and address on an identification envelope statement of voter before mailing absent voter's ballots to the elector, except that if the elector has a confidential voter registration record, as described in section 111.44 of the Revised Code, the board of elections shall not preprint the elector's address on the identification envelope statement of voter.
R.C. § 3509.04