261-25 Cerbo Submission.pdf

C.271 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 local unit no later than 10 days prior to the award of the contract. Part |—Vendor Information Ve di ay * Name: Ces Phe SP ony Cece gHouses, Caw Address: | 4/79 Litt ton Rod, City: [Py x2! Paws LNW State: | Zip. o7ds7 The undersigned being authorized to certify, hereby certifies that the submission provided herein represents compliance with the provisions of N.J.S.A. 19:44A4-20.26 and as represented by the Instructions accompanying this form. 4p {/ 7 : Q Signature 2 tinted Name Cath ‘o (peg Title y : ¢- Part (4 Contributior’ Disclosure ‘ Disclosure requirement: Pursuant to N.J.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. [1] Check here if disclosure is provided in electronic form. Contributor Name Recipient Name Date Dollar Amount 2 $ \ WA I\ “| yt 90