Resolutions - Jersey City

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C. 271 POLITICAL CONTRBUTION DISCLOSURE FORM .
Requied Puuant To N.J.S.A.. i9:~A-20.26
Thii form or its permited facsimle.mu8I be's.ubmiUed totle local uoit
no.later than 10 days prior to the award of the contract.
. The undersigned being authri to Cefy, heby cerfies. tht the submission pmvid~ ht.ei.rep~esents
compliance with the provisions ofN.J.S.A. 19:44A-20.26
and as reesented by the Intrction accompanyig ths
~....... Gijum.n ~o0ca
Part 11- ContrblJtion Disclosure
Disclosue requirement: PusWit to.N.J,S.A .i9;44A~20.26,th~ Çlisclosui-c must inc1uùt: all reportab1e
political contrbutions. (Jloreth $300 per election cycl~) over the. 12 months prior to sumision to the ':
commttees of the goverent entities listed on the form provided by the local unt.
o Check here if disclosur i~ provided in electronic form.
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Contriblitor Name Recipient Name ... Date Dollar Amount
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