HomeMy WebLinkAbout9/15/2023 - Elect EmilyRec’d by City Clerk 9’/5c90 33
COMMITTEE REGISTRATION/TERMINATION FORM
Date of Election ~November 23 0 Other
Type of Committee (check only one)
Candidate Committee I ~Small Scale Issue Committee
0 Issue Committee (Note:if you have not received contributions or made
0 Political Committee I expenditures in an aggregate amount exceedingI$200,no registration is required at this time.)
atck 5%A~~)~pO\Ut4t~U~~
Street Address (including city/state/zip)Mailing Address (if different)
~r4epcn&tnt ~fl~*~tA3\2b3 6 t vta-fr~€tvt ~fl
Name of Registered Agent for Committee Registered Agents Phone No
jit 1lfl (S’44&J
Must be filed with City Clerk before accepting or making any contributions.(City Code §7-134)
s this an amendment to,or termination of a previous registration
U No.This is a new registration.
M’Yes.Reason for amendment:(‘)fv~.fl%.e_u~&~cAcAv<cs
U 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 ou acronyms)Phone No.
%t31 CYZ&+r-te.dv
~;-~Q~O
Email Address Web Site Address
Purpose or Nature of Interest of the Committee
C\gc*i’oyi s4 \oc~ftn~a~*,5n~’~.&~~ws At ~Co’.uv-~s.Q)h~~
Name and Address of Financial Institution in which contributions are deposited (in a separate
account bearinq the name of the Committee).Must provide written documentation of such account.
Registered Agent’s Mailing Address Registered Agents Email Address
2*%i C.kSJokv~-cc~4r
~Colii~nc e~
Acknowledgement and Certification of Candidate
I
and Registered Agent
Signature of Candidate
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.
Date Signature of Registered Agent Date
ALL F ELDS ARE REQU RED