Form 17 "Ohio Secretary of State Verification of Accessible Polling Locations" - Ohio

What Is Form 17?

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 March 1, 2020;
  • 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 17 by clicking the link below or browse more documents and templates provided by the Ohio Secretary of State.

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Download Form 17 "Ohio Secretary of State Verification of Accessible Polling Locations" - Ohio

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Form 17 Prescribed by Secretary of State (03/20)
Ohio Secretary of State Verification of Accessible Polling Locations
R.C. 3501.29(B)(1)(a), (c) and (d)
This form must be completed and submitted prior to each election.
County Board of Elections
This verification is for the following election (select only one):
Primary Election to be held on (MM/DD/YYYY)
General Election to be held on (MM/DD/YYYY)
Special Election to be held on (MM/DD/YYYY)
Choose One:
I verify that all polling locations within the aforementioned county are accessible to
voters with disabilities and in full compliance with the Americans with Disabilities Act
and R.C. 3501.29(B)(1)(a), (c) and (d) based upon our findings using the Polling Place
Accessibility Checklist issued by the Secretary of State.
The aforementioned county cannot verify at this time that all polling locations are all
accessible to voters with disabilities and in full compliance with the Americans with
Disabilities Act and R. C. 3501.29(B)(1)(a), (c) and (d) based upon our findings using
the Polling Place Accessibility Checklist issued by the Secretary of State. Attached is a
plan for compliance.*
Director's Signature
Date (MM/DD/YYYY)
Deputy Director’s Signature or
Date (MM/DD/YYYY)
Board Chairperson’s Signature
Return this signed verification statement before Election Day to
swarren@ohiosos.gov.
print clearly
Form 17 Prescribed by Secretary of State (03/20)
Ohio Secretary of State Verification of Accessible Polling Locations
R.C. 3501.29(B)(1)(a), (c) and (d)
This form must be completed and submitted prior to each election.
County Board of Elections
This verification is for the following election (select only one):
Primary Election to be held on (MM/DD/YYYY)
General Election to be held on (MM/DD/YYYY)
Special Election to be held on (MM/DD/YYYY)
Choose One:
I verify that all polling locations within the aforementioned county are accessible to
voters with disabilities and in full compliance with the Americans with Disabilities Act
and R.C. 3501.29(B)(1)(a), (c) and (d) based upon our findings using the Polling Place
Accessibility Checklist issued by the Secretary of State.
The aforementioned county cannot verify at this time that all polling locations are all
accessible to voters with disabilities and in full compliance with the Americans with
Disabilities Act and R. C. 3501.29(B)(1)(a), (c) and (d) based upon our findings using
the Polling Place Accessibility Checklist issued by the Secretary of State. Attached is a
plan for compliance.*
Director's Signature
Date (MM/DD/YYYY)
Deputy Director’s Signature or
Date (MM/DD/YYYY)
Board Chairperson’s Signature
Return this signed verification statement before Election Day to
swarren@ohiosos.gov.