Free PRECINCT SUMMARY STATEMENT - Indiana

REPLACEMENT OF CANDIDATE NOMINATED BY PETITION
State Form 48518 (R6 / 10-07) Indiana Election Commission (IC 3-8-6-17)

Reset Form

(CAN-40)

INSTRUCTIONS: This form is used when a minor party candidate nominated by petition ceases to be a candidate after the petition is circulated for signatures and the party wishes to fill the resulting ballot vacancy. This form may not be used to replace an independent candidate. This form must be filed no later than NOON, September 9, 2008, before the general election. (IC 3-8-6-17) The candidate's consent (CAN-20 form) must be attached.
STATE OF INDIANA COUNTY OF ___________________________________ TO THE _______________________________________ COUNTY ELECTION BOARD OR INDIANA ELECTION DIVISION:

I certify the following: (1) I am the state chairman of the ______________________________ Party, a party entitled to nominate candidates by petitions of nomination under Indiana Code 3-8-6 or a local chairman of this party authorized to act under IC 3-8-6-17(c). (2) A petition circulated for signatures sought to place the name of ____________________________________ in nomination for the office of ______________________________________________. (3) On or about ________________________, 20_____ the above named individual ceased to be a candidate due to the (check one) death disqualification OR withdrawal of the individual. If the candidate

withdrew, a copy of the notice of withdrawal is attached to this form. (4) The following individual ______________________________________, who resides at the following address _____________________________________________________________________________ has consented to be substituted for the above named candidate as candidate for that office. A copy of the substitute candidate's consent (CAN-20 form) is attached to this form. (5) The following individuals were also included on the petitions of nomination circulated for signatures. Each of these individuals has consented to the substitution of this candidate on the petition, and a copy of their consent is attached to this form.

CERTIFIED, THIS THE ________ DAY OF ____________________________, 2008:
Signature of Party Chairman Printed Name and Title of Chairman