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Conservation Voters for Idaho Action Fund�e APPOINTMENT AND CERTIFICATION OF POLITICAL TREASURER a1 Rev. 1/15 FOR CANDIDATES AND COMMITTEES _ (Please Print or Type) sr `Q 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): ❑ CANDIDATE: Q✓ COMMITTEE: Miscellaneous: ❑V Measure: 11 Candidate/Measure: ❑ Name of Candidate: Home Work Cell Phone: Phone: Phone: Office Sought: Candidate Mailing address: Candidate email address: Name of Conservation Voters for Idaho Action Fund Committee: Nameof Committee Courtney Washburn Chairman: Home Work(208) 342-1264 Cell Phone: Phone: Phone: Committee Mailing address: PO Box 2802 Boise, ID 83701 Chairman email address: courtney@cvidaho.org CERTIFICATION AND APPOINTMENT Courtney Washburn , 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 cityclerk0 meridiancity. org Name of Political Treasurer: Courtney Washburn Home Work (208) 342-1264 Cell Phone: Phone: Phone: Mailing address: PO Box 2802 Boise, ID 83701 Treasurer 414 N Hillview Dr Boise, ID 83712 Residence address: Treasurer email address: courtney@cvidaho.org of Candidate or Committee Chairman Courtney Washburn , do hereby a�cept the appointment as political treasurer for Name of Political Treasurer the above named candidate or committee. IN 'f r Signature of Political Treasurer