Appointment of Treasurer, Victor Miller - Keep, Kevin - 9/2/2015G�ATSt APPOINTMENT AND CERTIFICATION OF POLITICAL TREASURER Rev. 08/07
FOR CANDIDATES AND COMMITTEES
(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:KeUi�i Kip
Home Work Cell
Phone: -o1 o— t(5�4(o Phone: alV20 -$333 Phone: `�/
�/�-- 36to - `7y yy
Office Seat (if
Sought: C I{y C w g C i( applicable)
Candidate
Mailing address: II(oO (- }+qIQ�� C +nele ��je�
Candidate
email address: keoty% @ w+yde*fs IIC - Cam
CERTIFICATION AND APPOINTMENT
I, � t ) 6 V1 a, 11 do hereby certify and appoint the following individual who is a registered elector of
Name of Candidate or Comrf+ittee Chairman
the State of Idaho as the political trea urer for the above named candidate or committee:
Name of
Political Treasurer: { t
Home rLtQ `b6�'3�+� Work � p, Cell
p
Phone: Phone: 1 � � - 1 - C W Phone: C) VA -t�
Treasurer A 1.' \1
Mailing address: 6 -1� Vim+, i -v jz 1 (\4 -V)6,j E-o,%\, \(, Y,)f��(p
RETURN THIS
FORM TO:
Sharon Bergmann
Clerk- Treasurer
City of Eagle
PO Box 1520
Eagle ID 83616
(208) 939 -6813
Fax: (208) 939 -6827
sharon @cityofeagle.org
Treasurer
email address:
Signature of Ca a or Committee Chairman
IWA do hereby accept the appointment as political treasurer for
Name of Political Treasurer
the above named candidate or committee.
ignature of Political Treasurer
Name of
❑ COMMITTEE:
Committee:
Name of Committee
Chairman:
Miscellaneous: ❑
Home Work Cell
Phone: Phone: Phone:
Measure: ❑
Committee
Mailing address:
Candidate /Measure: ❑
Chairman
email address:
CERTIFICATION AND APPOINTMENT
I, � t ) 6 V1 a, 11 do hereby certify and appoint the following individual who is a registered elector of
Name of Candidate or Comrf+ittee Chairman
the State of Idaho as the political trea urer for the above named candidate or committee:
Name of
Political Treasurer: { t
Home rLtQ `b6�'3�+� Work � p, Cell
p
Phone: Phone: 1 � � - 1 - C W Phone: C) VA -t�
Treasurer A 1.' \1
Mailing address: 6 -1� Vim+, i -v jz 1 (\4 -V)6,j E-o,%\, \(, Y,)f��(p
RETURN THIS
FORM TO:
Sharon Bergmann
Clerk- Treasurer
City of Eagle
PO Box 1520
Eagle ID 83616
(208) 939 -6813
Fax: (208) 939 -6827
sharon @cityofeagle.org
Treasurer
email address:
Signature of Ca a or Committee Chairman
IWA do hereby accept the appointment as political treasurer for
Name of Political Treasurer
the above named candidate or committee.
ignature of Political Treasurer