238-25 Exhibit B.pdf

(. 27] POLITICAL CONTRIBUTION DISCLOSURE FORM Required Pursuant To N.J.S.A, 19:444-20.26 ‘This form or its permitted facsimile must be submitted to the Ineal unit no later than 10 days prior to the award of the contract, Part I~ Vendor Information Vendor Name: | @ZABOCASCA COpyeTeananW, hoe Address [7-0 NO ZH iith Ave City: [WERT OLAHGE [States AVY [zip O70G7= The undersigned being authorized to certify, hereby certifies that the submission provided herein represents compliance with the provisions of NSA. 19:44A4-20.26 and as represented by the Instructions accompanying this form. Signature Fant &@ Mebourrla Printed Name FAOL LG CABO Tite PLES. OT Part fl - Contribution Disclosure Disclosure requirement: Pursuant to NwJ.S.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, 12] Check here if disclosure is provided in electronic form, "Contributor Name Recipient Name Date Dollar Amount fa Cr a ra. Mf fe fi ff joie PRA is