Township Council Meeting — Packet

C. 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/) i Vendor Name | kT 2 ( (024, Address: VA’ Rede yal bah city: | NA aye [Staté:_ xf] Ze: DKF AT TOIT ee my 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 Instructio! lero mpanying this form. UP Ge pman oe ail In Dna fh. pL fiiexe Signals Pidted Name 7 Title Part ll — Contribution 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 $ (Check here if the information is continued on subsequent page(s) P-42