BLANK FORMS. Mr. Form of judge's certificate. , LAWRENCE, September 22, 1855. SIR: Having entire confidence in your integrity, patriotism, and ability, you have been selected and are hereby appointed as one of the judges of the election to be holden in your precinct, in the Territory of Kansas, at on the second Tuesday, (October 9th, 1855,) for members of a convention to form a constitution, adopt a bill of rights for the people of Kansas, and take all needful measures for organizing a State government preparatory to the admission of Kansas into the Union as a State. Per order executive committee of Kansas Territory: J. K. GOODIN, Secretary. J. H. LANE, Chairman. Oath. I, do swear that I will perform my duties as judge of the election to he held at in the election district of the Territory of Kansas, to the best of my judgment and ability; that I will keep a true, correct, and faithful record or list of all persons who shall vote at said election; that I will poll no ticket from any person who is not an actual inhabitant and resident of said Territory, and whom I shall not honestly believe to be a qualified voter according to the provisions of the act of Congress organizing said Territory; that I will reject the votes of all non-residents who I shall believe have come into the Territory for the mere purpose of voting; that in all cases where I am ignorant of the voter's right, I will require a legal evidence thereof by his own oath or otherwise; and that I will truly count and record the votes received, and make a true and faithful return thereof to the executive committee of Kansas Territory. Sworn before me, this day of 1855. List of voters who have cast their ballots for delegates to a convention to form a constitution for Kansas, held on this second Tuesday, the ninth day of October, A. D. 1855. We, the undersigned, judges and clerks of election, hereby certify upon our oaths, that the whole number of legal votes cast at an election held at precinct, in Kansas Territory, on the seoond Tuesday of October, 1855, it being the ninth day of said month, between the hours of 10 o'clock, a. m., and 4 o'clock, p. m., of said day, for the election of delegates to a convention to form a constitution, adopt a bill of rights for the people of Kansas, and take all needful measures for organizing a State government, preparatory to the admission of Kansas as a State, to be We, the said judges and clerks, further certify upon our oaths, that the said voters were white male inhabitants, citizens of the United States above the age of twenty-one years, bona-fide residents of said Territory of Kansas, having actually resided therein for the period of thirty days immediately preceding said election day. OCTOBER 9, 1855. Judges. ATTEST: } Clerks. Tally-list of votes cast for delegates to a convention to form a constitution for Kansas, held on this second Tuesday, the ninth day of October, A.D. 1855. We, the undersigned, judges and clerks of election, hereby certify upon our oaths, that has received votes cast at an election held at precinct, in Kansas Territory, on the second Tuesday of October, 1855, it being the ninth day of said month, between the hours of 10 o'clock, a. m., and 4 o'clock, p.m., of said day, for delegates to a convention to form a constitution, adopt a bill of rights for the people of Kansas, and take all needful measures for organizing a State government, preparatory to the admission of Kansas as a State. We, the judges and clerks of said election, further certify upon our oaths, that the said voters were white male inhabitants, citizens of the United States, above the age of twenty-one years, bona-fide residents of said Territory of Kansas, having actually resided therein for a period of thirty days immediately preceding said election day. OCTOBER 9, 1855. ATTEST: Clerks. Judges. ADOPTION OF A CONSTITUTION. DECEMBER 15, 1855. Poll-book of voters who have cast their ballots at an election held on the 15th day of December, A. D. 1855, at Lawrence precinct, in district No. 1, in Kansas Territory, on the adoption or rejection of a constitution for the State of Kansas, and upon the general bankinglaw clause and black-law proposition. 1 James H. Lane 3 William L. Brigden 7 W. K. R. Blacmore 8 G. P. Lowry 9 H. N. Bent 10 D. N. Conger 11 J. L. Crane 12 R. S. Bassett 13 C. F. Doy 14 Levi Charles, jr. 15 Wm. Kitchenman 16 P. R. Brooks 17 G. S. Leonard 18 C. P. Farnsworth 19 Henry Arthurton 20 S. J. Pratt 21 H. A. Hancock 22 Wm. Hutchison 23 Joseph Sheilds 24 G. W. Deitzler 25 J. W. Hopping 26 J. H. Green 27 B. C. Galliday 28 C. C. Hyde 29 Morris Hunt 30 G. W. Smith 31 R. G. Elliot 32 Edwin Emerson 33 G. W. Rhineback 34 Oscar Harlow 35 S. M. Kirdy 36 J. P. Purdy 37 H. N. Simpson 38 Fred. Kimball 39 A. A. Saxton 40 Richard Knight 42 A. R. Burdett 51 W. N. Baldwin 52 Daniel Lowe 53 S B. Bacon 54 John Mack 55 Benton Oakley 56 Am. Whitlack 57 S. E. Knight 58 J. M. Colburn 59 F. A. Muzzy 60 Charles Robinson 61 E. D. Lyman 62 A. P. Knowles 63 Edward Monroe 64 A. J. Gabert 65 C. N. Henley 66 J. G. Crocker 67 H. A. Campbell 68 Benjamin Johnson 69 J. B. Conway 70 R. H. Waterman 71 William Andrews 72 E. D. Whipple 73 N. L. Byant 74 John Day 75 Robert Buffune 76 S. P. Brown 77 R. F. Hooton 78 J. J. Geraud 79 J M. Gillis 80 G. M. Buffune 81 R. H. Kimball 82 Adam Johns 83 M. D. Earl 84 Arthur Gunther 85 D. K. Aright 86 S. N. Hardwell 87 L. B. Dennis 88 S. Whitehorn 89 C. Clemens 90 Joshua Shaxter 91 J. W. Morey 92 J. A. Pike 93 Charles Gavin 94 A. Saddis 95 Clark Stearnes 98 Columbus Hornsby 99 N. S. Storiz 100 Edward Clark 101 Edward Ainslow 105 B. G. Livingston 124 L. M. Cox 129 Stephen Logue 130 Ferdinand Fuller 144 Joseph Cracklin 152 Joseph Hutchinson 153 Milan Grout 154 Otis Wilmoth 155 L. D. Coleman 156 Alexander Meyers 157 William Carles 158 John Pierson 159 David Parington 160 M. R. Clough 161 Noah Cameron 162 James Blood 163 H. P. Cutting 164 J. S. Jones 165 Allen Ham 166 Joshua Smith 167 S. J. Willis 168 Henry Green 169 Henry Smith 170 John Smith 171 Pleasant Kirby 172 Sol. Everett 173 B. S. Richardson |