HomeMy WebLinkAbout11/26/2024 - Chris for Council FCRec’d by City Clerk
COMMITTEE REGISTRATION/TERMINATION FORM
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Type of Committee (check only one)
W Candidate Committee C Small Scale Issue Committee
C Issue Committee (Note:if you have not received contributions or made
C]Political Committee expenditures in an aggregate amount exceeding$200,no registration is required at this time.)
n amendment to or termination of a previous registrat on2
No.This is a new registration.
C Yes.Reason for amendment:________________________________________________
C 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 acrony Phone No
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Street Address (including city/state/zip Mailing Address if ifferent)
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Email Address Web Site Address
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Purpose or Nature of Interest of the Committee
account bearing the name of the Committee)Must provide written documentation of such account
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Name of Registered Agent for Committee Reg stered Agents P one No
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Registered Agents Mai ng Address Registered Agents 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 Signature of Registered Agent
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Must be filed with City Clerk before accepting or making any contributions.(City Code §7-134)
Name and Address of Financial Institution in which contributions are deposited (in a separate
ALL FIELDS ARE REQUIRED