Fillable APPOINTMENT OF ASSISTANT TOWN CLERK, AND/OR ASSISTANT REGISTRAR (State of Connecticut/Department of Administrative Services)

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APPOINTMENT OF ASSISTANT TOWN CLERK, AND/OR ASSISTANT REGISTRAR (State of Connecticut/Department of Administrative Services)

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ED-636.2 Rev. 05\03 - G:\forms\ED-600s
APPOINTMENT OF ASSISTANT TOWN CLERK, AND/OR ASSISTANT REGISTRAR OF VITAL STATISTICS
File with Elections Services Division, Secretary of the State, 30 Trinity Street, P.O. Box 150470, Hartford CT 06115-0470)
TOWN OF _____________________________________________
I/We hereby certify that the following person(s) was/were appointed to the positions indicated:
PLEASE NOTE!! Terms of office MUST be listed and MUST include beginning and ending dates. For indefinite terms, please provide beginning date followed by the word "indefinite."
___________________________________ _______________________________________ _______________________________________ ___________________________________
(Assistant Town Clerk - Name) (Term: beginning and ending dates) (Address of Appointee) (Signature of Appointee)
___________________________________ _______________________________________ _______________________________________ ___________________________________
(Assistant Town Clerk - Name) (Term: beginning and ending dates) (Address of Appointee) (Signature of Appointee)
___________________________________ _______________________________________ _______________________________________ ___________________________________
(Assistant Town Clerk - Name) (Term: beginning and ending dates) (Address of Appointee) (Signature of Appointee)
___________________________________ _______________________________________ _______________________________________ ___________________________________
(Asst. Reg. Vital Statistics - Name) (Term: beginning and ending dates) (Address of Appointee) (Signature of Appointee)
___________________________________ _______________________________________ _______________________________________ ___________________________________
(Asst. Reg. Vital Statistics - Name) (Term: beginning and ending dates) (Address of Appointee) (Signature of Appointee)
___________________________________ _______________________________________ _______________________________________ ___________________________________
(Asst. Reg. Vital Statistics - Name) (Term: beginning and ending dates) (Address of Appointee) (Signature of Appointee)
___________________________________ _______________________________________ _______________________________________ ___________________________________
(Asst. Reg. Vital Statistics - Name) (Term: beginning and ending dates) (Address of Appointee) (Signature of Appointee)
The appointment(s) listed on this form were made by ____________________________________________________________ on ______________________________________ pursuant to the
Title(s) of Appointing Official(s) Date(s) of Appointment(s)
following law(s): ____________________________________________________________________________________
C.G.S. Section(s), charter section(s), or ordinance section(s)
Please fill out ALL APPLICABLE SECTIONS that follow:
FOR APPOINTMENTS OF ASSISTANT TOWN CLERKS FOR APPOINTMENTS OF ASSISTANT REGISTRARS OF VITAL STATISTICS
(Check, if applicable) Appointment was made under §7-19. (Check, if applicable) Appointment was made under §7-38.
____________________________________________________ _____________________ _________________________________________________ _________________________
(Signature Town Clerk) (Date signed) (Signature Town Clerk OR Register of Vital Statistics) (Date Signed)
********** PLEASE SEE REVERSE FOR ADDITIONAL INFORMATION ********* ********** PLEASE SEE REVERSE FOR ADDITIONAL INFORMATION *********
Reset Form
ED-636.2 Rev. 05\03 - G:\forms\ED-600s
Assistant Town Clerks
Assistant Town Clerks are appointed under the provisions of the town charter or ordinances, or, if the charter and ordinances do not provide for the appointing of Assistant Town Clerks, the
Town Clerk appoints under the provisions of Section 7-19 of the Connecticut General Statutes. The Town Clerk must file notice of ALL APPOINTMENTS of Assistant Town Clerks, whether
made under the provisions of the town charter, ordinances, or Section 7-19, with the Office of the Secretary of the State within ten (10) days after the appointments are made.
Sample signatures of appointees and term beginning and ending dates for appointees are required by the Office of the Secretary of the State so that the Office can authenticate documents signed
by Assistant Town Clerks.
Assistant Registrars of Vital Statistics
Assistant Registrars of Vital Statistics are appointed under the provisions of the town charter or ordinances, or, if the charter and ordinances do not provide for the appointing of Assistant
Registrars of Vital Statistics, under the provisions of Section 7-38 of the Connecticut General Statutes. ALL APPOINTMENTS of Assistant Registrars, whether made under the provisions of the
town charter, ordinances, or Section 7-38, MUST be reported to the Office of the Secretary of the State within ten (10) days after the appointments are made. Notices of appointments MUST be
filed with the Secretary of the State by the Town Clerk who is, ex officio, Registrar of Vital Statistics for the town, or by the elected or appointed Registrar of Vital Statistics.
Not more than four (4) Assistant Registrars of Vital Statistics may be appointed under the provisions of Section 7-38.
Sample signatures of appointees and term beginning and ending dates for appointees are required by the Office of the Secretary of the State so that the Office can authenticate documents signed
by Assistant Registrars.
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APPOINTMENT OF ASSISTANT TOWN CLERK, ANDOR ASSISTANT REGISTRAR (State of ConnecticutDepartment of Administrative Services)

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Completed 13 August 2020

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