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Form No. 48. Prescribed by the Secretary of State (06/10)

CERTIFICATE OF CHOICE BY COMMITTEE TO FILL VACANCY IN NOMINATION

R.C. 3513.31(F)

(To be filed with the Secretary of State, or the Board of Elections of the most populous County

of the District, or the appropriate County Board of Elections, not later than

the 86

day before the day of the general election.)

TO: ________________________________________________________

The undersigned respectfully certify that on the _________ day of _____________________, ___________,

___________________________________________________________________________________ did file a

nominating petition to be a candidate for the office of ____________________________________________; and

That a vacancy exists in the nomination, occasioned by the death of the candidate on the ____________ day

of ___________________________, ____________; and

That the undersigned, constituting the duly authorized committee to represent the candidate in the case of

death, did on the ___________ day of ______________________________, ___________ meet and nominate

the following person to replace said candidate:

Name: _____________________________________________________________________________________

Voter Registration Address: ____________________________________________________________________

Signatures and addresses of duly authorized committee: