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Declaration of Political Treasurer C-1 FormTo: APPOINTMENT AND CERTIFICATION OF POLITICAL TREASURER C-1 Rev. 1/15 a FOR CANDIDATES AND COMMITTEES (Please Print or Type) ' r r Qr�w� Pursuant to Section 67-6603(cl), 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): Name of ❑ CANDIDATE: Candidate: Home Phone: Office Sought: Candidate Mailing address: Candidate email address: Name of ❑ COMMITTEE: Committee: Name of Committee Chairman: Miscellaneous: ❑ Home Phone: Measure: ❑ Committee Candidate/Measure: ❑Chairman Mailing address: email address: Work Phone: Work Phone: CERTIFICATION AND APPOINTMENT Cell Phone: Cell Phone: I, , 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: Please remit to: City Clerk's Office City of Meridian 33 E. Broadway Ave. Suite 104 Meridian, ID 83642 (208) 888-4433 cityclerk@merid ian city. org Home Work Cell Phone: Phone: Phone: Treasurer Mailing address: Treasurer Residence address: Treasurer email address: Signature of Candidate or Committee Chairman I, , do hereby accept the appointment as political treasurer for Name of Political Treasurer the above named candidate or committee. Signature of Political Treasurer