STATE OF WISCONSIN
Town of ________
________ County
To the clerk of ________ County, Wisconsin:
I, ________ ________, clerk of the Town of ________, ________ County, Wisconsin, certify that upon the question of the division of the town, which was voted on by ballot, after due notice, at the last annual town meeting, a majority of the votes cast in one of the proposed subdivisions was in favor of division.
In witness whereof I have hereto set my hand this ____ of ________, 20__.
[Signature of town clerk]
