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