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