HomeMy WebLinkAbout3/31/2025 - Elect EmilyRec’d by City Clerk
COMMITTEE REGISTRATION/TERMINATION FORM
Date of Electon ~November 20i61 D Other
Type of Committee (check only one)
Candidate Committee LI Small Scale Issue Committee
o Issue Committee (Note:if you have not received contributions or madeexpendituresinanaggregate amount exceeding
O Political Committee $200,no registration is required at this time.)
Is this an amendment to,or termination of,a previous registration?
0 No.This is a new registration.
~Yes.Reason for amendment:C’avvIiAt*-.cow ~k~’\w
0 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
Ma~or
Name and Address of Financial Institution in which contributions are deposited (in a separate
account bearing the name of the Committee).Must provide written documentation of such account.
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Name of Registered Agent for Committee Registered Agent’s Phone No.
Registered Agent’s 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.
Signature of Candidate Date Signature of Registered Agent Date
14
ust be filed with City Clerk before accepting or making any contributions.(City Code §7-1 34)
3/SI/ts
ALL FIELDS ARE REQUIRED
03-31-25