2009-04Memorandum of Agreement for Polling Places
Precinct # 15
The Owner (Occupant) agrees to provide a polling place for the following 2 elections:
Primary Election: Tuesday, August 24, 2010
General Election: Tuesday, November 2, 2010 at the following location:
Jenkins Auditorium, 691 W. Montrose St.
POLLING PLACE TELEPHONE NUMBER: 3 52- 394-4191
To the extent sovereign immunity has been waived, the County of Lake agrees to indemnify and hold harmless the
owner for any claims for bodily injury or property damage occurring on the occupied premises arising from negligent
acts of the County or any of its agents or employees. Lake County agrees to pay the amount of $ for
each election held at the above location.
CHECK SHOULD BE MADE PAYABLE TO:
MAILING ADDRESS:
Do you have Tables and Chairs available for the election board members to use on election day? Yes No
YOUR SPECIAL INSTRUCTIONS regarding use of building, delivery of equipment, election day, pickup of
equipment and any other instructions you may have.
Person(s) to contact for access to building preceding election for delivery of voting equipment, 6:00 A.M. election day
for poll workers and after the election for pickup of voting equipment.
IF POSSIBLE PROVIDE TWO CONTACT PEOPLE
Name Margie Tingley
Address 691 W Montrose Street Clermont, Florida 34711
Name Ray San Fratello
Address 691 W Montrose Street Clermont, FL 34711
Phone Number 352-394-4191
****OR**,~,~
A KEY CAN BE OBTAINED FROM Name Margie Tingley
Phone Number 352-394-4191
Address 691 W. Montrose St
PLEASE FILL IN ALL INFORMATION
NEEDED AND RETURN ONE COPY
IN THE ENCLOSED ENVELOPE
Signature of Owner (Occupant) Tracy Ackroyd, City Clerk
685 W. Montrose Street
352-241-7332
THANK YOU FOR YOUR COOPERATION
Election Office Phone Number
352-343-9734
Emogene W. Stegall
Lake County Supervisor of Elections
P. O. Drawer 457, Tavares, Florida 32778
3/18/2009