PRESIDENTIAL ELECTOR: CERTIFICATE OF VOTE (IEC-18) State Form 40654 (R51 8-12)
Indiana Election Commission (IC 3-10-4-9)
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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