Bernt, TregAPPOINTMENT AND CERTIFICATION OF POLITICAL TREASURER c
Rev. 08/077
t� FOR CANDIDATES AND COMMITTEES
o
r) �� (Please Print or Type)
Pursuant to Section 67-6603(cl), Idaho Code. No contribution shall be received or expenditure'mpds by orbehalf of a
candidate or political committee until he or she appoints a political treasurer and certifie(fitne and address of the treasurer
to the Secretary of State,«FF
Certification is for (check appropriate box below): 1, Ks 0,C ifC7
1 Name of
CANDIDATE: l Candidate; - -_ (
Home Work Cell
Phone: Phone: Phone: off. j
Office Seat (if
Sought: t applicable)
Candidate
Mailing address; ( PIC ivi k� � �' -t r` 1 10 '
Candidate
email address: ) f a f
Name of
❑ COMMITTEE: ,Committee:
i Name of Committee
i Chairman:
Miscellaneous: El !Home Work Cell
Phone: Phone: Phone:
Measure: 1-1 lCommittee
Mailing address:
Candidate/Measure: El
Chairman
email address:
CERTIFICATION AND APPOINTMENT
do hereby certify and appoint the following individual who is a registered elector of
Name of Candidate or Committee Chairman
the State of Idaho as the political treasurer for the above named candidate or committee:
Name of �-
Political Treasurer: t
1 Home Work Cell t
Phone: Phone: Phone: }
Treasurer i
Mailing address: { t A d ,_I
I Treasurer
I email address: ) CI'
-
ignature f Candidate or Committee Chairman
I, f do hereby accept the appointment as political treasur for
Name of Political Treasurer
the above named candidate or committee= t
ignature of Political Treasurer
CAMPAIGN FINANCIAL DISCLOSURE REPORT
SUMMARY PAGE
(Please Print or Type)
Section I
C-2
Rev, 12/14
Name of ndi to or P litical ommi a and Chairperson
I/
Office Sought if candidate)
District (if any)
c.
Mailing ressi
17 <x .
an Zip
l
Home on
o one
Name o o Uca reasurer
g f
Mailing Address
a
City and Zip
t
Home Phone
'' q
WO—K Phone
i
Change of address for: Candidate or Political Committee ❑ Political Treasurer ❑
Section II TYPE OF REPORT
This filing is an: ' Original ❑ Amendment
This report is for the period from , through / - /l
❑ 7 Day Pre -General Report
Is this a Termination Report: ❑ Yes
❑ 30 Day Post -General Report
❑ October 10 Pre -General Report
Annual Report
Section III STATEMENT OF NO CONTRIBUTIONS OR EXPENDITURES
Directions: If you had no contributions or expenditures during this reporting period, check the box next to the statement below and sign this report.
Be sure to carry forward the appropriate "Calendar Year to Date" figures in Column II, Section IV,
Iess
I hereby certify that I have received no contributions and have made no expenditures during this reporting period,
Section IV SUMMARY
To reach your Calendar Year to Date figure: Add this report's Column I
figures to the Column II figures of your previous report (except on line 6).
Line 1: Cash on Hand January 1, This Calendar Year*
Line 2: Enter Beginning Cash Balance**
Line 3: Total Contributions (Enter amount from line 5, page 2)
Line 4: Subtotal (Add lines 1, 2 and 3)
Line 5: Total Expenditures (Enter amount from line 11, page 2)
Line 6: Enter Ending Cash Balance (Subtract line 5 from line 4)
Line 7: Outstanding Debt to Date (Enter amount from line 18, page 2)
COLUMN I
COLUMN II
This Period
Calendar Year
to Date
$ XXXXXX
$ Ll 09f
$ ( F
$ XXXXXX
$ �—
$ —
$
$
$
$ _
$01 V,$
$_
*This same figure should be entered on line 1 of all reports filed this calendar year,
**This is the figure on line 6 of the last Campaign Financial Disclosure Report filed. If this is your first report, this amount is 0.
Note: The closing cash balance for the current reporting period appears on the next report as the beginning cash on hand.
Section V
Please remit to:
City Clerk's Office
City of Meridian
33 E. Broadway Ave.
Suite 104
Meridian, ID 83642
(208)888.4433
cityclerk@meridiancity.org
I, rt hereby certify that the information in this
Name of Political Treasurer
report is a true, complete and correct Campaign Financial Disclosur Report as require by law,
( 1,41-1 A—
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re of Political Treasurer