HomeMy WebLinkAbout6/27/2025 - Susan for City CouncilRecd by City Clerk L27 Z —
COMMITTEE REGISTRATION/TERMINATION FORM
Reg stered Agen ‘s Mail ng Address Registered Agent’s Email Addres
Acknowledgement and Certification of Candidate and Regstered
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 intenti•nal
misrepresentation of facts may result in denial of a registration and that falsification of statements on and with
this attestation may bepunishable bylaw.________________________________________
Signature of Candidate Date Signature of Registered Agent
Date of Election
ype of Committee (check only one)
r Novemberfl.g_,a-’~0 Other _________
Candidate Committee C Small Scale Issue C.mmittee
C Issue Committee (Note:if you have n•t received contributi.ns •r male
C Political Committee j expenditures in an aggregate amount exceeding$200,no registration is required at this time.)
Is II is an amendment to,or termination of a previous registration?
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 ef the C•mmittee.(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.
Street Address (including city/state)zip)
•G~-t cE~0i V’<.,Co ~?
Maiting Address (if different)
77o~~4 3c
Email Address Web Site Add
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Name and Address of Financia Institution in which contributions are deposited (in a separate
account bearing the name of the Committee).Must provKie written_documentation of such accou
Name of Registered Agent for Committee Registered Agent’s Phone No.
nt.
~Sc4ub~t\~
U
ust be fil:.“ith City Clerk before a~pting or making any ontributions.(ity Code §7-134)
F DSARE REQUIRED