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Commonwealth of Virginia

TO ALL TO WHOM THESE PRESENTS SHALL COME - GREETING:

This is to Certify, that at a meeting of the Electoral Board of the County/City of ______________, held on (enter date of canvass), 2010, on an examination of the official records deposited in the office of the Clerk of the Circuit Court it was ascertained and determined that at the election held on (enter date of election), 2010,

Successful Y. Candidate

was duly elected

(enter office title and district, if any)

For a term commencing (enter date)*, 2010

and ending (enter date), 20___.

Witness the following official Signature and the Seal of the Board at ______________, Virginia, this (enter numerical date – e.g. first, second, fifteenth etc.) day of (enter month), 2010.

___________________________________

Secretary

* Note: For a Special Election to fill a vacancy enter: For a term commencing upon qualification, 20___ and ending (enter date), 20___.

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