Treg Bernt Political Treasurer�A� ski APPOINTMENT AND CERTIFICATION OF POLITICA ER C-1
Rev. 1115
FOR CANDIDATES AND COMMITTEES
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Pursuant to Section 67-6603(cl), Idaho Code. No contribution shall be recd� 0j re made by or on behalf of a
candidate or political committee until he or she appoints a political treasurer and ceriifie�_ress of the treasurer
to the Secretary of State,
Certification is for (check appropriate box below):
Name of
0 CANDIDATE: Candidate: t+Ue �� L/l1' N j �V
Home Work Cell
Phone: Phone: Phone: (� `1
— — - -- --- — - — I --
Office *�
Sought: I C VJ l v C L
Candidate
Mailing address: C2 ` S , `�' � � �� iJ
Candidate
email address: 1$c iv—'"(! (ri !M I" L,
Name of
❑ COMMITTEE: Committee:
Name of Committee
Chairman:
Miscellaneous: ❑ Home Work Cell
Phone: Phone: Phone:
Measure: ❑
Committee
Candidate/Measure: Mailing address:
---- ------ ---- ----
Chairman
email address:
CERTIFICATION AND APPOINTMENT
I, '� ►� (pit; (GvT 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. [Ji O A & L ifs v
Home Work Cell � _�� '6
Phone: Phone: Phone:
Treasurer '�1
Mailing address ZL 70 �C✓�I�i.0 �12 1�(� 1��7 -1 f✓� &-N (a
Treasurer
Residence address:
Treasurer )Please remit to:
email address: D (_� O A L J �i L A I
A
City Clerk's Office
City of Meridian
33 E. Broadway Ave. g ature of C� didate or Committee Chairman
Suite 104
Meridian, ID 83642
(208) 888-4433 I, _ b � V. do hereby accept the appointment as political treasurer for
clerk@meridiancity.org Name of Political easurer
the above named candidate or committee.
Signature of`Po tical Treasurer
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