Form 50 "Census Block Reprecincting Waiver Form" - Ohio

What Is Form 50?

This is a legal form that was released by the Ohio Secretary of State - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2021;
  • The latest edition provided by the Ohio Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 50 by clicking the link below or browse more documents and templates provided by the Ohio Secretary of State.

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Download Form 50 "Census Block Reprecincting Waiver Form" - Ohio

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Form 50 Prescribed by Secretary of State (04/2021)
Census Block Reprecincting Waiver Form
please print clearly
The
County Boards of Elections respectfully requests that the Secretary of State
waive the ORC 3501.18 (B) (1) requirement to draw precinct boundaries using U.S. Census Bureau geographical units for
the precinct(s) listed below for the reasons(s) indicated.
Waiver Request Number:
Municipal Corp./Township:
Precinct(s) Involved:
Reason for Request to split a Census Block into two or more precincts. (Please check one or more below.)
Without splitting a Census Block the precinct will contain more than 1,400 registered voters.
Without splitting a Census Block the resulting precinct would contain less than 1,400 but more than
registered voters and is expected to increase beyond the 1,400 threshold.
Without splitting a Census Block, the “continuity” of a neighborhood would be compromised. (e.g. an isolated
suburban residential development that is a single precinct and following census boundaries would segregate
selected residents by placing them into another precinct)
The boundary between the school districts listed below passes through the Census Block and it is important to
retain precinct boundaries that coincide with school district boundaries.
School Districts that share a Census Block:
1.
2.
The Census Block is extensive in geographic size and/or is elongated in shape. The Census Block must be split into
two or more precincts to prevent unusual hardships for voters in travel to voting locations.
Other (Please explain in detail on attached document)
Map number
is attached, showing the relevant, existing and proposed precinct boundaries, and census
block(s) boundaries indicating proposed split(s).
Please attach any relevant documentation that may assist in reviewing this request including voter registration totals
for the relevant current precincts and the proposed precincts.
Contact information for further clarification:
Name:
Phone:
Title:
Fax:
Address:
Submitted by:
Printed Name:
Title:
Date
Signed
Please send this request (including maps and relevant documentation) by one of the following methods to:
Ohio Secretary of State’s Office
Re: Census Block Waiver
Email: SWVRD@OhioSoS.gov, or
U.S. Mail: P.O. Box 2828, Columbus, OH 43216
Form 50 Prescribed by Secretary of State (04/2021)
Census Block Reprecincting Waiver Form
please print clearly
The
County Boards of Elections respectfully requests that the Secretary of State
waive the ORC 3501.18 (B) (1) requirement to draw precinct boundaries using U.S. Census Bureau geographical units for
the precinct(s) listed below for the reasons(s) indicated.
Waiver Request Number:
Municipal Corp./Township:
Precinct(s) Involved:
Reason for Request to split a Census Block into two or more precincts. (Please check one or more below.)
Without splitting a Census Block the precinct will contain more than 1,400 registered voters.
Without splitting a Census Block the resulting precinct would contain less than 1,400 but more than
registered voters and is expected to increase beyond the 1,400 threshold.
Without splitting a Census Block, the “continuity” of a neighborhood would be compromised. (e.g. an isolated
suburban residential development that is a single precinct and following census boundaries would segregate
selected residents by placing them into another precinct)
The boundary between the school districts listed below passes through the Census Block and it is important to
retain precinct boundaries that coincide with school district boundaries.
School Districts that share a Census Block:
1.
2.
The Census Block is extensive in geographic size and/or is elongated in shape. The Census Block must be split into
two or more precincts to prevent unusual hardships for voters in travel to voting locations.
Other (Please explain in detail on attached document)
Map number
is attached, showing the relevant, existing and proposed precinct boundaries, and census
block(s) boundaries indicating proposed split(s).
Please attach any relevant documentation that may assist in reviewing this request including voter registration totals
for the relevant current precincts and the proposed precincts.
Contact information for further clarification:
Name:
Phone:
Title:
Fax:
Address:
Submitted by:
Printed Name:
Title:
Date
Signed
Please send this request (including maps and relevant documentation) by one of the following methods to:
Ohio Secretary of State’s Office
Re: Census Block Waiver
Email: SWVRD@OhioSoS.gov, or
U.S. Mail: P.O. Box 2828, Columbus, OH 43216