PRESIDENTIAL ELECTOR: CERTIFICATE OF VOTE (IEC-18) State Form
40654 (R51 8-12)
Indiana Election Commission (IC 3-10-4-9)
1Ve, Inc unaersriJlletf, auEy electetf alia quafijiea as dectors
Jar tlie (Presiaellt tlllIl'Vice4nsiaent oj tlie 'U,ritea Statl! if
j[men'ca for tlie respect ive tenus 61!oimring on tlie twentietli
tfay ojJa nuary 2013 in alldfor tlie State of lIufiana, as appears
6y tfit al!71l!J(etfcmiJicates maiuu[ tI llaaeu'verea I'D lis 6y
tne qowmorof tnis tate, its eliiife:(J!cuti'IJe officer, naviTlO
met aliaconvellea agreea6fy to tne prurlisiotlS of tfie (aw, ill
tfie (nam6er of tnc Inaia t/a J{ouse of I/{fpresetrtatives at
Indianapofis, Itlllwtla (In tliefirst ~(lnaay after t fie sceom!
1Vetincsaa) ill lDecem6er, 2012, 6eino tlie seve1Iteentfi tfay of
tliis montfi.
(Do nere6y certify, t fiat 6eino so assem6feti anti tiufy
organizca, we proceeaea to vote 6) 6aUot, alia 6aUoteafirst f or
Presiaent and tfill ll fo r Viee-
PRESIDENTIAL ELECTORS: CANVASS AND CERTIFICATION OF (IEC-1S)
VOTE TO FILL VACANCY IN OFFICE OF PRESIDENTIAL ELECTOR State Form
40649 (R7 18-12)
Indiana Election Commission (IC 3-10-4-8)
TO: The Honorable Governor of Indiana:
We. the undersigned. duly elected and qualified Electors for
President and Vice-President of the United States in and for
the
State of Indiana, certify that being so assembled , determined
that Beverly Bush , a duly elected and qualified Elector has
resigned, has been certified as disqualified , or has failed to
appear by eleven a.m. We have proceeded to vote. by ballot. to
fi ll such vacancy pursuant to Title 3, United States Code,
Section 4 and IC 3-10-4-8.
We certify the foregoing canvass of all votes cast to fill the
vacancy:
Name of Candidate Number of Votes
10Scott Molin
Certificate
We further certify that pursuant to the above described canvass,
Scott Molin has received a majority vote of all Electors
present and request that you immediately notify such person of
the person's election in accordance with IC 3-10-4-8, and
present the Elector with a commission under IC 4-3-1 -5.
In Testimony whereof, we have hereunto set our hands on the
first Monday after the second Wednesday in December, 2012
being the 17'h day of said month at Indianapolis , Indiana.
Presidential Electors
Signature of Elector
Prin ted Name of Elector
