HomeMy WebLinkAbout5/1/2025 - Vote Shirley PeelREC’D BY CITY CLERK
Rec’d byt?~FI~4S’42
COMMITTEE REGISTRATION/TERMINATION FORM
Dateof Election ‘‘~
Type of Committee (check only one)
134 Candidate Committee
D Issue Committee
D Political Committee
f~J ~Nà\~Imber _____~~Other ________
D Small Scale Issue Committee
(Note if you have not received contribut ons or made
expenditures in an aggregate amount exceeding
$200,no registration is requred at this time.)
Is this an amendment to or termination of,a previous registration?
V No.This is a new registration.
C Yes.Reason for amendment:
o 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 (speW out acronyms)
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Street Address (including city/state/zip)
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Email Address
Purpose or Nature of Interest of the Committee
Cnncki data com~4ce~
Mailing Address (if dfferent)
Web Site Address
Phone No
q~o an
Name and Address of Financial Institution in which contr butions are deposited (in a
account bearing the name ofihT~Committee)Must provi Fitfëiidocument~iion of
\Jelts ra~o
Acknowledgement and Certification of Candidate and Registered Agent
separate
such account
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.
Signature of Req stered Agent
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Name of Registered Agent for Committee Registered Agent’s Phone No.
Registered Agents Mailing Address Registered Agent’s Email Address
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FC1 CU ?iO5~C
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C
Signature of Candidate
c-s Co~
Date
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Date
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