Form A "Election Day Technical Assistance Documentation Form" - Vermont

Form A is a Vermont Secretary of State form also known as the "Election Day Technical Assistance Documentation Form". The latest edition of the form was released in May 1, 2008 and is available for digital filing.

Download a PDF version of the Form A down below or find it on Vermont Secretary of State Forms website.

ADVERTISEMENT

Download Form A "Election Day Technical Assistance Documentation Form" - Vermont

811 times
Rate
(4.3 / 5) 57 votes
Election Day Technical Assistance Documentation Form A
To be Completed by Election Officials
Please use this form to document any Election Day technical assistance either by telephone or in
person from LHS Associates (Vermont’s vote tabulator servicing partner). Please note that both the
Presiding Officer and another election official must sign this form.
Election Date:__________________
Name of Election: __________________________________
Presiding Officer or Election Official who completed this form:_______________________________
Please describe the problem:___________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Please describe LHS’s response: ________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Other comments: ____________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
I swear or affirm that the above documentation is true and accurate.
__________________________________________
_______________________
Signature of Presiding Officer
Date
__________________________________________
_______________________
Signature of Person Completing Form or other Election Official
Date
Submit the original form to the Secretary of State’s Office, Elections Division, 128 State St.,
Montpelier, 05633 with your ORV form. Keep a copy for your records.
8-1
Rev. 5/2008
Election Day Technical Assistance Documentation Form A
To be Completed by Election Officials
Please use this form to document any Election Day technical assistance either by telephone or in
person from LHS Associates (Vermont’s vote tabulator servicing partner). Please note that both the
Presiding Officer and another election official must sign this form.
Election Date:__________________
Name of Election: __________________________________
Presiding Officer or Election Official who completed this form:_______________________________
Please describe the problem:___________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Please describe LHS’s response: ________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Other comments: ____________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
I swear or affirm that the above documentation is true and accurate.
__________________________________________
_______________________
Signature of Presiding Officer
Date
__________________________________________
_______________________
Signature of Person Completing Form or other Election Official
Date
Submit the original form to the Secretary of State’s Office, Elections Division, 128 State St.,
Montpelier, 05633 with your ORV form. Keep a copy for your records.
8-1
Rev. 5/2008
ADVERTISEMENT