HomeMy WebLinkAbout2/25/2025 - Daisy for the PeopleRec’d by City Clerk 2 z5
COMMITTEE REGISTRATION/TERMINATION FORM
Date of Ilection C ApnI ______r November aoa~C Other _________
Type of Committee (check only one)____________________________________________
Candidate Committee El Small Scale Issue Committee
C Issue Committee (Note:if you have not received contributions or made
El Political Committee expenditures in an aggregate amount exceedingI$200,no registration is required at this time.)
Email Address Web Site Address
Purpose or Nature of Interest of the Committee
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Signature n~Cdnclidate Date Signature of Registered_Agent Date
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Is this an amendment to,or termination of,a previous registration?
tsY’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 acronyms)Phone No.
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Street Address (including city/state/zip)Mailing Address (if different)
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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 Agents Phone No.
Mailing Address
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Registered Agent’s Lmail Address
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.
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ALL FIELDS ARE REQUIRED