Treasurer Certification Moberly Seat 6QAz APPOINTMENT AND CERTIFICATION OF POLITICAL TREASLIkE
FOR CANDIDATES AND COMMITTEES $Ia�1ao�Vo
H O
(Please Print or Type)
Pursuant to Section 67-6603(cl), 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):
Name of
CANDIDATE: Candidate:
Home work Cell
Phone:(a-W-15 Phone: Phone:6 rfiiU1AI,_i x,19]
❑ COMMITTEE:
Miscellaneous:
Office Seat (if
--,
SoughtPPlicable)
Candidate
Mailing address_-���� ,
Candidale
:mail address: -
Name of
Committee:
Name of Committee
Home Work
Phone: Phone:
Measure: ❑ Committee
Candidate/Measure: Mailing address:
Chairman
email address:
Cell
Phone:
CERTIFICATION AND APPOINTMENT
I,�, ��y do hereby certify and appoint the following individual who is a registered elector of
ameof;C' ddateor ommiuee irman
the State of Idaho as the political treasurer for the above named candidate or committee:
RETURN THIS
FORM TO:
Jaycee Holman
City Clerk
City of Meridian
33 E. BroadwayAve,
Meridian ID 83642
(208) 888-4433
Fax: (208) 888-4218
jholman@merldiancity.org
Name of
Political Treasurer:
Home
Phone: I �m�\
Treasurer
Mailing address: %{ i
Treasurer
email address:
Work
Phone:
Cell
Phone: U552'\ Da-
or Committee Chairman
s. do hereby accept P(appointment as political treasurer for
Name o Political Treasurer
the above named candidate or committee.
Signatnfe of Politi Treasurer