Committee Registrationvon
COCIIHADO
Committee Registration Form
Committee Name: E%act 14(ic/L<Y,/ ar 4wo",
Purpose/Office Supported: TTv0.-1 Tit w[,/C'
Committee Type (circle one): Candidate Committee .Political Committee Issue Committee
Registered Agent: )K fC /r C u r,,o
Contact Phone Number: q 7 O .? 9 o S-f 9 V
Physical Address: 2- 1z / /1 L 0.1S W . 4l 2-0 Mailing
Address: 10D -goX 2 1 W Edw cyuls, CU 3 L Affiliated
Candidate or Committee (if applicable): pt C / ca ,/- Authorization:
Registered
Agent's Name: Registered
Agent's Signature `, - %` Date: ze iZ Candidate'
s Name (if applicable): Candidate'
s Mailing Address (if applicable): foo Joy Z F `// Candidate'
s Signature (if applicable):Date: 3i 2c z Z vPage
1 of 1 Revised
July 2022 Item
5.2 — Committee Registration Form