HomeMy WebLinkAbout4/23/2025 - Adam Eggleston for MayorREC’D BY CITY CLERK
Rec’d by City cieri&’R23’25~’H4_12
COMMITTEE REGISTRATION/TERMINATION FORM
DateofElechon ,[I ApdI_____~November ~/Other_______
Type of Committee çcheck only one)________________________
Candidate Committee I [1 Small Scale Issue Committee
ii issue Committee (Note:if you have not received contributions or made
D political Committee expenditures in an aggregate amount exceeding$200,no registration is required at this time.)
Is this ar amendment to.or termination of.a previdus registration?
No.This is a new registration.
o 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 flnaJ Campaign Finance Report
showing a zero balance and mark the form as a termination report.)
Fufl Naime of Committee (spell out acronyms)Phone No.
I1c~aM E~48~L~cr V~’&yor
Street Address (including city/state/zin)Mahing Address (if different)
foR Po~Place
j~-4 QdI~v~.,e~
Email Address Web Site Address
,‘%,~-&c~~t~j 1.Con~
Purpose or Nature of Interest of the Committee
E~4aaL #o 41.ia twte 0r V’11yor i’v~44~202S
Parc 6,ttc.i~.elecjro.-t.
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.
Slot ~iàeta~k ~.Z2r0t r ~PS ~+Cc lien,C&
Name of Registered Agent for Committee Registered Agents Phone No.
Man %4eaL
Registered Agents Mailing Address -Registered Agents Email Address
2Z02 R~%?~
Fr4 ~a ~oc25
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.__________________________________
Signature of Candidate
.~e r:4~..-___~____re4r-r~f—-r City Clak before accepting or making ..‘‘“‘-(City Code §7-134)
Date Signature of Regf stared Agent