HomeMy WebLinkAbout4/11/2025 - Tricia for Fort CollinsSW
REC’D 8?CITY CLERK
Recd by City CIaUR11’25HH1LSR
COMMITTEE REGISTRATION/TERMINATION FORM
H.,.~~U.Date4ofElectIonA ~~pnI ______~November~b~c~~D Othk_________
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Type of Committee (check only one)_________________________________
Candidate Committee I C Small Scale Issue Committee
C Issue Committee (Note:if you have not received-contributions or made
C Political Committee I expenditures in an aggregate dmount exceedingI$200,no registration is retiuired at this time.)
Is this an amendment to,or termination of,a previous registration?
o No.This is a new registration...-
Yes.Reason foramendment ft9&t~f?t1t~3r o ?flc~-t’
O Yes.I wish to terminate the Committee and hereby state that the Committee has received no
contributions and made no expenditures since the original registration of the Committee.(Note:if the
Committee received contributions or made expenditures,you must file a final Campaign Finance Report
showing a zero balance and mark the form as a termination report.)
Full Name of Committee (spell out acronyms)-Phone No.
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Street Address (including city/state/zip)Mailing Address (if different)
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Email Address Web Site Address
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Purpose or Nature of Interest of the Committee
Name of Registered Agent for Committee Registered Agent’s Phone No.
Registered Agents Mailing Address Registered Agent’s Email Address
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Acknowledgement and Certification of Candidate and Registered Agent
I hereby acknowledge the foregoing information and certify and attest that all information above is true and
complete to the best of my knowledge,after reasonably diligent inquiry.I understand that any intentional
misrepresentation of facts may result in denial of a registration and that falsification of statements on and with
this attestation may be punishable by law.
Name and Address of Financial Institution in which contributions are deposited (in a separate
account bearina the name of the Committee).Must provide written documentation of such account.
Signature of Candidate Date Signature of Registered Agent Date
Must be filed with City ler
ALL FIELDS ARE REQUIRED