ELECT-410(E) No Adjudications to Report

Instructions:

Use this form if no adjudications have occurred during the preceding month. Submit this form to the Department of Elections as required by §24.2-410, no later than the 15th of each month. Clerks of Court serving two localities with no adjudications to report will need to submit the form for each locality.

Contact and Locality

Date: * +

Circuit Court Clerk First Name: *

Circuit Court Clerk Last Name: *

Email address

confirm email address here

Phone Number *

Adjudicated Incapacitated Report

Locality *

2nd Locality (if applicable):

There are no adjudications to report for the month of:

Month *

Year *