3e92bad8-f52d-484b-a442-ff61150b6e0e_Order3of2026_R__-_need_help-artifacted.pdf — PaddleOCR-VL (Baidu)

ADAMS COUNTY COURT OF COMMON PLEAS

AMERICANS WITH DISABILITES ACT (ADA) TITLE II NOTICE OF ACCOMMODATION

Name:	Home Phone (include area code):
Date of Notice:
Person with a Disability Information
Address:	Business Phone (include area code):
	Mobile Phone (include area code):
Court Service, Program, Court Case or Proceeding Related to Request
Date of Service, Program, Court Case or Proceeding
Type of Accommodation Requested:
Request for Reasonable Accommodation: ☐ Approved ☐ Alternate Accommodation Approved ☐ Request Denied
Type of Accommodation Approved:
Request for Accommodation was denied based on the following:


Grievance Procedure
The person with a disability, when an accommodation has been denied, may grieve the decision as a violation of the Americans with Disabilities Act to the President Judge of the 51st Judicial District. The grievance should be filed as soon as possible and no later than sixty (60) calendar days after the alleged violation. A Grievance Form may be obtained by contacting:\nAdams County Court Administrator\n117 Baltimore Street, 4th Floor\nGettysburg, PA 17325\n(717) 337-9846\n(717) 334-8817 (Fax)\ncourtadagrievance@adamscountypa.gov
Agency or Court: 51st Judicial District	Contact Person:
Address: 117 Baltimore Street, 4th Floor	Phone (include area code): (717) 337-9846
Gettysburg, PA 17325	Date Filed:
Signature:	Date:

(04/2024)