West Virginia Code Chapter 6. General Provisions Respecting Officers § 6-4-2. United States senator appointed to fill vacancy

When a vacancy shall occur in the representation of this state in the senate of the United States, and the same shall be filled by the governor by appointment under the provisions of chapter three, he shall, when requested, deliver to the person so appointed a certificate under his hand and the great seal of the state, which shall be substantially in the following form:

State of West Virginia, to-wit:

Whereas, ․․․․․․․․․․, who was duly chosen a senator of the United States in the manner provided by law, for the term ending on the third day of March, in the year ․․․, having (died, resigned, been removed, or otherwise ceased to be a senator, as the case may be):

Therefore, I, ․․․․․․․․․․, governor of the State of West Virginia, pursuant to the authority vested in me by law, do appoint ․․․․․․․․․․, of the county of ․․․․․․․․․․, a senator from this State in the senate of the United States, until the general election next to be hereafter held in the State of West Virginia, and until his successor shall have been chosen and shall have qualified.

Given under my hand and the great seal of the State of West Virginia, on the ․․․ day of ․․․․․․․․․․, ․․․.