Resolutions - Jersey City

C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM
Requied Pursuant To N.J.S.A. 19:44A-20.26
This form or its peried facsime must be.s.ubmitted to the loca unit
no. later than 10 days prior to the award ofile contract.
Th~ undersigned being authoried to cer, hereby certes tht the submission provided h~ei represents
. çornliance with the proVisions ofNJ.S.A. 19:44A-20:26'ancì as repesented by the Instctionsaccompanyig ths
form
e~'
Signtue .
Part ir - Cóntribl,tiqn Disclosure'
1? B~~.ì'~iò h
Prted Name
._,pres.
Title' ,
Disclosue requiement: Puùat to'N.J .S.A.19:44A-20.26this diclosue mus include al repertable
politi~a1 contrbutions (more th $300 per election cycle) over the 12:months prior to submission to the
commttees of the govern~t entities listed on the form provided br the local unt.
D Check here If disclos~e. is ., provided - in - electronic '- .. form.
Contributor Name Recipient Name Date Dollar Amount
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o 'Ch~ck here if the inormation is contiued on suseq1leDtpage(s)