Kristen PudlowRECETVET7
OCT 0 7 2019
ase APPOINTMENT AND CERTIFICATION OF POLITICAL TREAWRER,..,...,,; _ c-1
Rev. 1115
FOR CANDIDATES AND COMMITTEES CITY CLEF
(Please Print or Type)
r� 044 Pursuant to Section 67-6603(c1), Idaho Code. No contribution shall be received or expenditure made by or on behalf of a
candidate or political committee until he or she appoints a political treasurer and certifies the name and address of the treasurer
to the Secretary of State.
Certification is for (check appropriate box below):
IN�
❑ COMMITTEE:
Miscellaneous: F]
Measure:
Candidate/Measure: ❑
Name of
Candidate:
T - ---�-- T
Home
Phone:
Work Cell ,
/
-T—_V-- Phone - Phone_- 2,
Office
Sought:
—
�—
------____
Candidate
Mailing address, , ` CL,
Candidate
email address:-
,., - , , t `
Name of --------_—�____ --- -- --
Committee:
Name of Committee
Chairman:
Home Work Cell
Phone: Phone: Phone:
Committee � v
Mailing address:
Chairman
email address:
CERTIFICATION AND APPOINTMENT
I, 52U,r1�ov.) 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:
Please deliver to:
Chris Johnson
City Clerk
City of Meridian
33 E. Broadway Ave.
Suite 104
Meridian, ID 83642
cityclerk@meridiancity.
org
Name of
Political Treasurer:
C'
Home
Phone:
Work Cell
Phone: Phone:
Treasurer
Mailing address:
Treasurer
Residence address: Z, Li L4
Treasurer
email address:
f
Signature of Candi-rate or Committee Chairman
I, do hereby accept the appointment as political treasurer for
Mme of Politica Treasurer
the above named candidate or committee.
Signature of Political Treasurer