Appointment & Certification of Treasurer - Agrusa, Mary Frances - 11/26/2007C-1
Rev. 04/05
RECEIVED &
Pursuant to Section 67-7003(cl), Idaho Code. No contribution shall be receiv d or expencfgrY
OF EAG1::-
made by or on behalf of a candidate or political committee until the can date or political
committee appoints a political treasurer and certifies the name and address of t e treasurer No. r) ` Hoot
City Clerk. 'tVVUU II
File
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APPOINTMENT AND CERTIFICATION OF POLITICAL TREASURER
FOR
CANDIDATES AND COMMITTEES
(Please Print or Type)
Certification is for:
(check appropriate box)
0 CANDIDATE:
COMMITTEE:
Miscellaneous
Measure
0 Candidate. Measure
Name of Candidate Home Phone Work Phone Cell Phone
Office Sought Term Seat (if any)
Mailing Address of Candidate
e-mail Address
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Name bf Committee Chairman Home Phone Work Phone Cell Phone
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CERTIFICATION AND APPOINTMENT
, hereby certify and appoint the following individual who is a registered
Name of Candidate or Committee Chairman
elector of the State of Idaho as the political treasurer for the above named candidate or committee:
Name of Political Trea
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r Home Phone Work Phone Cell Phone
2L) W est Cnnif r y_oto ID(f21(40
Mailing Address of Political Treasurer
4,v8Eoli ve4rk3bleane. rlQ1-
e-mail Address
Srgn m•e o and date or Committee Chairman
I I Ytti,�j
am6cj hereby accept the appointment as the political treasurer for the above
e of Political Treasure
named candidate or committee:
RETURN THIS FORM TO:
Sharon Bergmann
City of Eagle
P.O. Box 1520
Eaele ID 83616
Thr
Signature of Political Treasurer