98-24 Signed agreement Reliable (1).pdf

(. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Required Pursuant To N.J.S.A. 19:44A-20.26 This form or its permitted facsimile must be submitted to the local unit no later than 10 days prior to the award of the contract. Part | - Vendor Information Vendor Name: | Waefurg's Corer Nd. bce Address: | Fuy_ poll Reap suite Ol City: | A alm&el State: Zip: 07733 The undersigned being authorized to certify, hereby certifies that the submission provided herein represents compliance with the provisions of N.J.S.A. 19:44A-20.26 and as represented by the Instructions accompanyingthis fon ‘ ps4 Steven Barn Printed Name Title Pres Deol / <e Part Il — Contribution Disclosure Signature Disclosure requirement: Pursuant to N.ILS.A. 19:44A-20.26 this disclosure must include all reportable political contributions (more than $200 per election cycle) over the 12 months prior to submission to the committees of the government entities listed on the form provided by the local unit. (J Check here if disclosure is provided in electronic form. Contributor Name Recipient Name Date Dollar Amount $ AoOVWiz 7 &