(ED-638c - Vacancy in Elective Office – Justice of the Peace 11/12)
To: Secretary of the State
30 Trinity Street
P.O. Box 150470 Section 9-184 of Conn. General Statutes
Hartford, CT 06115-0470
Attn: LEAD - OPW
VACANCY IN OFFICE OF JUSTICE OF THE PEACE
On _________________________, the office of
(Date Of Vacancy)
Justice of the Peace was vacated due to the
______________________________________________
(Manner In Which Vacancy Occurred)
of the incumbent,___________________________
(Name)
who was nominated for a term
from: _______________________________________
to: ________________________________________
APPOINTMENT TO FILL VACANCY FOR JUSTICE OF THE PEACE
On _____________________________________, pursuant to the provisions of
(Date)
Section 9-184 of the General Statutes
Mr.
Mrs.
Miss
Ms. ________________________________________________________________________
of _________________________________________________________________________
(Address)
was appointed by: ________________________________________________________
(Name Of Town Committee Or “By Town Clerk”)
to fill the vacancy in the office of Justice of the Peace
vacated by _______________________________________________________________
(Name Of Person Who Vacated Office)
on _______________________________________
(Date)
to serve until ___________________________________
(Date Appointment Expires)
Date _____________________ Town of __________________________________ Town Clerk ______________________________________________
