238-25 Exhibit B.pdf

C.271 POLITICAL CONTRIBUTION DISCLOSURE FORM Required Pursuant To N.J.S.A. 19:44A-20.26 i ‘This form or its permitted facsimile must be submitted to the local unit : neo later than 10 days prior to the award of the contract, Part !— Vendor Information Vendor Name; | Shaugeér Property Services, Inc. ‘Address: | 429 Dodd Street City: |" East Orange [ State: “NJ [ Zip: 07047 t 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 accompanying this form. Signature ——— ‘inted Name Linda M. Spahle Title Acting Secretary . Part ll ~ Contribution Disclosure Disclosure requirement; Pursuant to NJ.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. (C] Check here if disclosure is provided in electronic form. Contributor Name Recipient Name Date Sollar Amount Please see Political Contributions Disclosure Listing allached $ 15