Form No. 126-C Prescribed by Secretary of State (07-13)
REPORT FORM ON LOCAL QUESTIONS AND ISSUES
INSTRUCTIONS:
Use a separate form for each issue. It is the responsibility of the county board of elections to prepare and check ballot language for
proper form before submitting local questions and issues for approval. Attach a copy of the ballot language and a copy of the
resolution, ordinance, or petition and forward to the Secretary of State. Only the most populous county is to submit this report form
and ballot language for a question or issue overlapping into another county or counties.
COUNTY BOARD OF ELECTIONS
__________________________________
Subdivision: ____________________________________________________ Overlapping Counties
Yes
No
(Checking “yes” indicates your county is the most populous county for the question or issue.)
List overlapping counties __________________________________________________________________________
Date of Resolution:
__________________________________________
Date Filed with Board:
__________________________________________
Date of Election:
__________________________________________
Authority: R.C. Section:
__________________________________________
Percent Required for Passage:
__________________________________________
Ballot Language Prepared By: __________________________________________
__________________________________________________________________________________________________
BOND ISSUE
Amount: $__________________________________ Maximum number of years bonds to run: _____________________
Purpose: _________________________________________________________________________________________
__________________________________________________________________________________________________
Estimated __________mills for each one dollar of tax valuation which amounts to $ ___________________ for each one
hundred dollars of tax valuation
Commencing in ________________
__________________________________________________________________________________________________
TAX LEVY
Purpose: __________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Additional Renewal Replacement _________________ mills for ________________ years or CPT,
commencing in __________________
Renewal
Replacement of ______________ mills and increase of ______________ mills for _______________
years or CPT, commencing in __________________
Renewal
Replacement of _________________ mills being a reduction of _____________ mills for _________
years or CPT, commencing in __________________
Substitute $________________________ initial sum; of __________________ mills for ___________________
years or CPT, commencing in __________________
__________________________________________________________________________________________________
MISCELLANEOUS QUESTION
(Charter amendment, income tax, zoning, permissive tax, etc.)
Purpose: __________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
_______________________________
_________________________________________
Date
Director