Form 50 - Census Block Reprecincting Waiver Form
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1Form #50 Prescribed by Secretary of State (10-11)
CENSUS BLOCK REPRECINCTING WAIVER FORM
The __________________________________ County Board 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.)
1. _________ Without splitting a Census Block the precinct will contain more than 1,400 registered voters.
2. _________ Without splitting a Census Block the resulting precinct would contain less that 1,400 but more than
___________ registered voters and is expected to increase beyond the 1,400 threshold.
3. _________ 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)
4. _________ 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) ________________________________________
5. _________ 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.
6. _________ 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 _______________________
Signed _____________________________________________
Date ______________________
Please send this request (including maps and relevant documentation) by one of the following methods to:
Ohio Secretary of State’s Office
Attn: Patricia Wolfe, Elections Administrator
Email: pwolfe@ohiosecretaryofstate.gov, or
U.S. Mail: P.O. Box 2828, Columbus, OH 43216
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