HomeMy WebLinkAboutNew Committee Registration 2-1-2024FIRESTONE TOWN CLERK
9950 Park Avenue
Firestone, CO 80520
TownCierk@FirestoneCO.gov
Fax: (720) 713-4106
wwwjjrestpngco.rov
INUSIAnFORRITY
(145-108,
Below Space or Office Use Only
Please use this form if you are registering a new committee for Colorado campaign finance purposes.
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Select Only One Committee Type: I�N
(yCandidate Committee r State Political Committee mall Donor Committee Political Party
Issue Committee Small -Scale Issue Committee 527 Political Organization
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CommitteeName:
Name should be descriptive. Include office, organization name, etc. Note: Colorado does not have PACs, only Political Committees.
Committee Address (physical):
Committee Address (mailing):
Phone Number: 50:2 152,5 C>�16 Alternate Phone Number:
Check Only One Jurisdiction:
Municipal (file with Municipality)
Web Address:
COUNTY
Special District -------------- Enter Applicable
SchoolDistrict Counties
Fax Number: __a_i
Purpose/Office Sought (include party (NP), office, (NP) & election year, if applicable):
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Financial Institution Information:
Institution Name: fl(ir;�&
Institution Address: i_%�
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Registered Agent Design a ted ME
Name: Name: - . ..... ... .. ___kh --- ------- -
Phone Number: ;c.> 3, 5 2.5 t>-i ( Phone Number:
E-mail Address: �Airvvt04-4 1 C6 VA E-mail Address:_
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Alternate E-mail 1: NIA� Alternate E-mail 1:
Alternate E-mail 2: PA Alternate E-mail 2:
Agent: (Optional)
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Registere ent's Si tre: Designated Filing Agent's Signature:
X Date: _�L, _1?07_`fX Date:
Candidate Committee Complete the following:
Print Candidate Name:
Candidate Address (incl
Candidate Signature:
Firestone Town Clerk, Rev. 12/2023