Miss. Code. tit. 1, pt. 19, ch. 2, app A
2022 Mississippi Voting Modernization Act Grant Program ("MVMGP) Grant Application Form
County: _______________________________________________________
Person Completing Application: ________________________________________
Title/Position: _____________________________________________
Phone Number: ___________________________________________________
Fax Number: ______________________________________________________
Email:__________________________________________________________
Additional Documents Checklist. Please check all that apply:
Voting Systems:
_______ Copy of Contract/Invoice attached
_______ Verification from Vendor that Systems does not utilize pre-scored punch card ballots, produces voter verifiable paper ballots; and does not have capability for remote wireless connection. (For the purposes of this grant, capability for remote wireless connection includes having internal hardware that could allow for wireless communication such as wi-fi or Bluetooth.)
Other Eligible Expenses:
_______ Copy of Contract/Invoice attached
_______ Verification that existing voting systems already in compliance with MVMGP
_______ Affidavit of no existing debt
_______ If existing systems not already in compliance with MVMGP, certification that grant money will only be applied to other eligible expenses from funds remaining after applicant county is in compliance with MVMGP
Outstanding Indebtedness:
_______ Certification from voting system vendor as to balance owed.
_______ Copy contract and purchase order
_______ Verification from Vendor that Systems does not utilize pre-scored punch card ballots, produces voter verifiable paper ballots; and does not have capability for remote wireless connection. (For the purposes of this grant, capability for remote wireless connection includes having internal hardware that could allow for wireless communication such as wi-fi or Bluetooth.)
Table A: Total Grant Request
Grant Area | Details and Proposed Date of Purchase | Proposed Cost |
Voting Systems | Type of System: __________________ Date of Purchase: __________________ Vendor: __________________ Manufacturer and Model No of System: __________________ __________________ | $ |
Other Eligible Expenses | Itemized other eligible expenses: _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ | $ $ $ $ $ $ $ $ $ $ $ |
Outstanding Indebtedness owed for existing voting systems (attach required documentation) | Type of System: ________________ Date of Purchase: ____________ Vendor: ____________ Manufacturer and Model No of System: __________________ __________________ | $ |
Subtotal voting systems | $ | |
Subtotal other eligible expenses | $ | |
Outstanding Indebtedness | $ | |
TOTAL | $ |
Miss. Code. tit. 1, pt. 19, ch. 2, app A