Dom Gelsomino Political TreasurerFC UV D
� z
11 r _, i
f"
APPOINTMENT AND CERTIFICATION OF POLITICAL TREi k Rev.
FOR CANDIDATES AND COMMITTEES
(Please Print or Type)
Pursuant to Section 67-6603((1), Idaho Code, No contribution shall be received or expenditure made by or on behalf
oandidate or political committee until he or she appoints a political treasurer and certifies the name and address of the treat
to the Secretary of State.
Certifica ion is for (check appropriate box below):
NDIDATE; I Name of
C
Candidate: a try) Ct~ 150Mi r?0
Home Work cell
Phone: Phone; Phone: Z057
Office �r��,,
Sought: Nlewtci1Qn C-14.1 Coo Vic,;
!Canddate
,Mailing address: Ap4% 115-42001"e,+J iA ii, tp e%42—
Candidate �`` i JJ `�
:email address: C0k�r't dot -n `t ickt k , cQrte,,
❑COMMITTEE: CommiNamoofttee:
Name of Committee
Chairman:
Mis Ilaneous: ❑ Home Work Cell
Phone: Phone: Phone:
Measure: ❑ -Committee
Mailing address:
Candida Measure:
,Chairman
; email address:
CERTIFICATION AND APPOINTMENT
I, r aWli O- l:�V o , do hereby certify and appoint the following individual who is a registered elect(
Nar le of Candidate or Committee Chairman
the Sta e of Idaho as the political treasurer for the above named candidate or committee:
Name of `x +
Political Treasurer rD Mh n t�� W
Home Work cell
Phone: Phone: Phone;
Treasurer61C
Treasurer
Mailing address;
Treasurer S l 4 C uv&
Residence address;
Please remit to; Treasureremail address: �"�` 1. �� � �- Y'nS
City Clark's Office
City of Meridian
33 E. Brc adway Ave,'
Suite 104,nature of ndidate or Committee Chairman
�r
Meridian iv 83842 1W__2L/(At�A do hereby accept th appointment as political treasurer,
(zoe) 66 -4433Name of Political Treasurer
the above named candidate or committee.
Signature of political Treasurer
1
5
to
rer
r of