Election Vote Count Report Form
Use this form to report official election vote-count results, ballot reconciliation details, and submission certification.
Election and Reporting Details
Election Name / Title
*
Election Type
*
Please Select
General
Primary
Local
Special
Runoff
Other
Jurisdiction / Area Covered
*
Polling Station / Precinct Name or Number
*
Report Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Report Time
*
Hour Minutes
AM
PM
AM/PM Option
Report Status / Stage
*
Please Select
Preliminary
Final
Amended
Revised
Other
Vote Count Totals
Total Registered Voters
*
Total Ballots Issued or Received
*
Total Valid Votes Cast
*
Total Invalid or Spoiled Ballots
*
Blank Ballots
Turnout Percentage
Candidate or Option Breakdown
Candidate or Option Breakdown
*
Candidate / Option Name
*
Votes Received
*
Include Write-In Votes
Yes
Ballot and Tally Reconciliation
Unused Ballots
*
Spoiled or Replaced Ballots
Seals, Box Numbers, or Ballot Box Identifiers
Reconciliation Note or Discrepancy Explanation
Certification and Submission
Reporting Officer Name
*
First Name
Middle Name
Last Name
Role / Title
*
Contact Phone or Email
*
Signature
*
Submission Notes or Comments
Submit Report
Submit Report
Should be Empty: