Committee RegistrationAvon
C O! O R A C O
Committee Registration Form
Committee Name: L LtC 10_ ot a,n (. a411 06( I Purpose/
Office Supported: _ CD11JY) 0,,/0 C Committee
Type (circle one): idate Comm tee olitical Committee Issue Committee Registered
Agent: or D- Z ( Contact
Phone Number: C320 Zq(-a - r
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Address: L A C ca o Mailing
Address: PO OCK (Q 09 Z t , ( , ( n F ( (g Affiliated
Candidate or Committee (if applicable): Authorization:
Registered
Agent's Name: / {,c I Registered
Agent's Signature Date: Zoz Candidate'
s Name (if applicable): aa
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Mailing Address (if applicable): ` )o xy OCI 2- Yn , / 0 l 0 Candidate's Signature (
if applicable):"`'Date: l 2U ZZ Page 1 of
1 Revised July 2022
Item 5.2 —
Committee Registration Form