HomeMy WebLinkAbout5/22/2025 - Josh For CouncilREC’D BY CITY CLERK
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Rec’d by Cty R~D BY CITY CLE
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COMM ITTEE REGISTRATION/TERMINATION FORM
Date of Election -Li November zolS C Other _________
p o on mittee (check only one)
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Name and Address of F’nancial 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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tered Agents Mailing Address Registered Agents Email Address
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Acknowledgeme t 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 Cand’date Signature of Registered Agent Date
F.___________
rust be filed ~“th City Clerk before accepting or ma ‘ng any Co ‘butions.(City Code §7-134)
r Candidate Committee C Small Scale Issue Committee
C Issue Committee (Note:if you have not received contributions or made
El Political Committee expenditures in an aggregate amount exceeding$200,no registration is required at this time.)
Is this an amendment to,or termination of a previous registration2
1W No.This is a new registration.
El Yes.Reason for amendment:__________________________________________________
C Yes.I wish to terminate the Committee and herely state that the Committee has received no
contributions and made no expenditures since the .riiinal relistration of the Committee.(Note:if the
Committee received contributions or made expenlitures,yiu must file a final Campaign Finance Report
showing a zero balance and mark the form as a terminati.n report.)
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H Name o omniittee (spell out acronyms)Phone No.
Street Address (includ ng city/state/zip)Mailing Address (if different)
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A Web Ste Address
Purpose or Nature of Interest of the Committee
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Name of Registered Agent for Committee Registered Agent’s Phone No
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ALL FIELDS ARE REQUIRED