Form 20-C Hhs Polling Location Accessibility Equipment Disposal Form - Ohio

Form 20-C is a Ohio Secretary of State form also known as the "Hhs Polling Location Accessibility Equipment Disposal Form". The latest edition of the form was released in September 1, 2017 and is available for digital filing.

Download a PDF version of the Form 20-C down below or find it on Ohio Secretary of State Forms website.

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Form 20-C Prescribed by Secretary of State (09-17)
HHS Polling Location Accessibility Equipment
print clearly
Disposal Form
The Ohio Secretary of State’s Office has adopted a policy regarding the permanent transfer, temporary transfer, and disposal of
accessibility equipment paid for by Health and Human Services Grant funds for polling location accessibility. This form must be
used for the proper disposal of accessibility equipment.
The
County Boards of Elections has accessibility equipment that is no longer in
working condition due to weatherization or damage and will therefore dispose of the equipment in accordance with the
aforementioned policy listed below as of this
day of
,
.
Please list the quantity of equipment, a brief description of the equipment and the reason(s) for disposal of the equipment.
Quantity
Description of Item
Reason(s) for Disposal
If you need more space, please attach a list of items, quantity and the reason for disposal.
The County Board of Elections shall maintain accurate records of all equipment disposed of in the event of relevant audits,
claims, litigation, negotiations or other proceedings regarding the disposal of accessibility equipment originally purchased with
Health and Human Services grant funding.
Date (MM/DD/YYYY)
BOE Director's Signature
Date (MM/DD/YYYY)
BOE Board Chair's Signature
SOS USE ONLY
The Secretary of State’s office has approved the disposal of the above list of accessibility equipment.
Date (MM/DD/YYYY)
ADA Coordinator’s Signature of Approval
Form 20-C Prescribed by Secretary of State (09-17)
HHS Polling Location Accessibility Equipment
print clearly
Disposal Form
The Ohio Secretary of State’s Office has adopted a policy regarding the permanent transfer, temporary transfer, and disposal of
accessibility equipment paid for by Health and Human Services Grant funds for polling location accessibility. This form must be
used for the proper disposal of accessibility equipment.
The
County Boards of Elections has accessibility equipment that is no longer in
working condition due to weatherization or damage and will therefore dispose of the equipment in accordance with the
aforementioned policy listed below as of this
day of
,
.
Please list the quantity of equipment, a brief description of the equipment and the reason(s) for disposal of the equipment.
Quantity
Description of Item
Reason(s) for Disposal
If you need more space, please attach a list of items, quantity and the reason for disposal.
The County Board of Elections shall maintain accurate records of all equipment disposed of in the event of relevant audits,
claims, litigation, negotiations or other proceedings regarding the disposal of accessibility equipment originally purchased with
Health and Human Services grant funding.
Date (MM/DD/YYYY)
BOE Director's Signature
Date (MM/DD/YYYY)
BOE Board Chair's Signature
SOS USE ONLY
The Secretary of State’s office has approved the disposal of the above list of accessibility equipment.
Date (MM/DD/YYYY)
ADA Coordinator’s Signature of Approval
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