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Pennsylvania Election Incident Report
Incident Reporter and Location Information
*
1.
Incident Reporter
(Required.)
Name
Email Address
Phone Number
2.
County
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Blair
Bradford
Bucks
Butler
Cambria
Cameron
Carbon
Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Dauphin
Delaware
Elk
Erie
Fayette
Forest
Franklin
Fulton
Greene
Huntingdon
Indiana
Jefferson
Juniata
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
McKean
Mercer
Mifflin
Monroe
Montgomery
Montour
Montour
Northampton
Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill
Snyder
Somerset
Sullivan
Susquehanna
Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
*
3.
Location of Incident
(Required.)
Location (personalized descriptor)
Precinct # (Enter NA for MIB Processing Centers)
*
ZIP/Postal Code
*
*
4.
Which type of incident are you reporting?
(Required.)
Location
Voter/Ballot
Other (please specify)
Current Progress,
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