the municipal secretary desktop reference manual - Southwestern ...

DCED-CLGS-19-5 Form MS-914 04 075 5
Report of Elected and Appointed O f f i c i a l s Township
of Pennsylvania Second Class Townships - 199 County of
INSTRUCTIONS: Review all information provided and make corrections in the space provided o n
t h e r i g h t s i d e o f t h e r e p o r t . L i s t o t h e r o f f i c e s n o t s h o w n o n r e p o r t i n s p a c e s provided
in the last page of this report. Return three copies to the PA Department of Transportation,
Bureau of Municipal Services, Transportation and Safety Building, Harrisburg, PA 17120. One
original copy and office machine copies are acceptable. Mail i m m e d i a t e l y a f t e r f i r s t m e e t i n g
o f t h e y e a r . D o n o t h o l d b e c a u s e o f v a c a n c i e s . Advise us when vacancies are filled and
when changes occur during the year. The April check for your township's share of Liquid Fuels
Taxes will not be mailed until this form and all other required forms are received.
Federal EIN (Employers Identification Number): 25-
Days of Month of Regular Meeting of Supervisors:
(Insert Fed. EIN if not shown)
Please show contact person for business and telephone number - 8 AM to 5 PM:
Al CONTACT PERSON
Al CONTACT PERSON
___________________________________________
Telephone Number ( ) _____ - ______ Telephone Number ( ) _____ - ______
Fax Number ( ) _____ - ______ Fax Number ( ) _____ - ______
A2 MUNICIPAL BUILDING ADDRESS (If Any)
TOWNSHIP
A2 MUNICIPAL BUILDING ADDRESS (If Any)
_________________________________________
_________________________________________
P. O. _________________________________________
TOWN, PA
_________________________________________
31 SECRETARY 31 SECRETARY
_________________________________________
_________________________________________
P. O. BOX _________________________________________
TOWN, PA
_________________________________________
Telephone Number ( ) _____ - ______ Telephone Number ( __ ) _______ - __________
Sex: M___ F___ (If Applicable)
Sex: M___ F___ (If Applicable)
02 CHAIRMAN 02 CHAIRMAN
_________________________________________
ROAD
_________________________________________
TOWN, PA
_________________________________________
Telephone Number ( ) _____ - ______ _________________________________________
Political Affiliation R
Telephone Number ( ___ ) ______ - __________
Year Term Ends: 00 Sex: M___F____
Political Affiliation ____
Year Term Ends: 00 Sex: M___F____
03 SUPERVISOR 03 SUPERVISOR
_________________________________________
_________________________________________
TOWN, PA
_________________________________________
Telephone Number ( ) _____ - ______ _________________________________________
Political Affiliation R
Year Term Ends: 98 Sex: M___F____
Telephone Number ( ______ ) ______ - ________
Political Affiliation ____
Year Term Ends: ___ Sex: M___F____
IMPORTANT! SIGN AND DATE LAST PAGE OF REPORT BEFORE FILING
DCED-CLGS-19-5 Report of Elected and Appointed O f f i c i a l s 04 075 5
V-25