HomeMy WebLinkAbout3/28/2025 - Hirschhorn for MayorReed byCty Clerk 2’..—Zc )4E0.
COMMITTEE REGISTRATION/TERMINATION FORM
Date of Election 0 April ______0 November 0 Other
Type of Committee (check only one)
Candidate Committee U Small Scale Issue Committee
O Issue Committee (Note:if you have not received contributions or made
o Political Committee expenditures in an aggregate amount exceeding$200,no registration is required at this time.)
Is this an amendment to or termination of,a previous registrat on?
No.This is a new registration.
0 Yes.Reason for amendment:____________________________________________________
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 rep.rt.)
Full Name of Committee (spell out acronyms)Phone No.
N;5ct~Orn f~r Nayôr 7H’-I/q 17q3
Street Address (includ ng city/state/zip)Mailing Address (if different)
5o80 Ro351{ElvJ.~t~D(0
Porf Co(11’i51(.O ‘?0525
Email Address Web Site Address
~rutcctop~O5 2q@ ooftoofrconi I
Purpose or Nature of Interest of the Committee
T0 e(ecf ild~~~1-(trsct4icrv~
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.
Registered Agent’s Phone No.
-7~q’1-/jq I7~3
Registered Agent’s Mailing Address Registered Agent’s Email Address
5Øg&fo’gi’/gi~4 rItt/%
Fort Cot I~ni 1C0 ~B525 5er~c 4p ~
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 ma be •unishable b law.
Date Signature of Registered Agent Date
4ãi~6(1~
Name of Registered Agent for Committee
Signature_of Candidater
Mus •e filed with City Clerk before accepting o aking any ontributions.(City ode §7-134)
ALL FIELDS AR REQU RED