Treg Bernt 2019APPOINTMENT AND CERTIFICATION OF POLITICAL TREASURER c
Rev. 08/077
t� FOR CANDIDATES AND COMMITTEES
o
r) �� (Please Print or Type)
Pursuant to Section 67-6603(cl), Idaho Code. No contribution shall be received or expenditure'mpds by orbehalf of a
candidate or political committee until he or she appoints a political treasurer and certifie(fitne and address of the treasurer
to the Secretary of State,«FF
Certification is for (check appropriate box below): 1, Ks 0,C ifC7
1 Name of
CANDIDATE: l Candidate; - -_ (
Home Work Cell
Phone: Phone: Phone: off. j
Office Seat (if
Sought: t applicable)
Candidate
Mailing address; ( PIC ivi k� � �' -t r` 1 10 '
Candidate
email address: ) f a f
Name of
❑ COMMITTEE: ,Committee:
i Name of Committee
i Chairman:
Miscellaneous: El !Home Work Cell
Phone: Phone: Phone:
Measure: 1-1 lCommittee
Mailing address:
Candidate/Measure: El
Chairman
email address:
CERTIFICATION AND APPOINTMENT
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: t
1 Home Work Cell t
Phone: Phone: Phone: }
Treasurer i
Mailing address: { t A d ,_I
I Treasurer
I email address: ) CI'
-
ignature f Candidate or Committee Chairman
I, f do hereby accept the appointment as political treasur for
Name of Political Treasurer
the above named candidate or committee= t
ignature of Political Treasurer