HomeMy WebLinkAboutNew Committee Registration Form 01-29-2024Fwsrow To CLFRx
9950 Park Avenue,
Firestone, CO 80520
lownCierk@FirestaneCO.gov
Ph. (303) 531,6264
fax. (720) 713-4105
NEW COMWITTEE REGISTRATION FORM, LRLe"0_EQ1;i
1 4S-108, CAS
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Select Only Out Committee Type:
'Candidate Committee (— State Political Committee Small Donor Committee Political Party
Issue Committee I— Small-Scaie Issue Committee r— 527 Political Organization
Committee Name:
Conimillce Address (physical), —1
Committee Address (mailing):
Phone Number:
rice. OrgAMMwfion name, ek"'Nate, (oww-adal
Alternate Phone Number
Check Only One Jurisdiction: Web Address,
COUNTY
Special District ............. Enter Applicable
Counties
Municipal (file math Mturd palit V) School District
i'"f hal v 11AC a, ffild, 11g,fi81c11 < vulalimrs,
Purpose/Office Sought (include party (NP),, office, (NP) & election year, if applicable):
Financial Institution Information:
Institution Name-
lnsfitubonAddress:
Authorized Agents Contact Information:
Registered Agent: Designated Filing Agent: (Optional)
Name- b-11, 44i"o Z, Name:
Phone Number- Phone Number.
L`.-Fnail Address- t I r, ^rva E-mail Address -
Alternate E-mail I- Alternate F—mail L
Alternate E-mail 2: Alternate E-mail 2 -
Registered Agent's Signature: Designated Filing Agent's Signature:
Dale: I Date,:
Candidate Committee Complete, t1he fbllowtng
Print Candidate',lama c.
C andidate Address (include mailing).4,—) t�
Candidate Signature:
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