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Form 1

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“. . . . . . . . . . . . . . who was chosen United States Senator of the State of Arkansas, in pursuance of the Constitution of the United States of America, having died (resigned, or otherwise, as the case may be): Therefore, I, . . . . . . . . . . . . . ., Governor of the State of Arkansas, have appointed . . . . . . . . . . . . . . United States Senator to fill the said vacancy temporarily until the election of a United States Senator by the qualified electors of the state

Given under my hand and the seal of the said state this . . . . . . day of . . . . . ., 20. . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Governor of the State of Arkansas Attest: . . . . . . . . . . . . . ., Secretary of State”

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Form 1