STATE OF WISCONSIN
Town of ________
________ County
The undersigned, inspectors of the special election held in the Town of ________, ________ County, Wisconsin, on ________ ___, 20__, upon the question of approving initial bond resolution No. ________, for bonding the town for $________ to [insert the purpose of the issue], do hereby certify that at the close of the election and in the polling place, we publicly canvassed all of the ballots cast, without adjournment or intermission, and at once publicly announced the result of the election.
The following is a statement of the result of the canvass:
Dated this ______ day of ________, 20__.
[Signatures of election inspectors]
Filed in my office ________ ___, 20__.
Recorded in the town bond record book on page ________, on ________ ___, 20__.
[Signature of town clerk]
