- Candidates running for office in the 2013 elections who wish to receive public funds must file this certification form with the New York City Campaign Finance Board by June 10, 2013. Late or incomplete forms will not be accepted.
- The form requires candidates to provide contact information for themselves, their treasurer, principal committee, and campaign bank accounts. It informs candidates about requirements for using the CFB's online reporting system and provides other important information about the public financing program.
- Properly filing this certification form by the deadline makes candidates eligible to receive public funds for their campaigns if they meet the program's requirements.
This 6-page document is an IRS Form 433-A (Collection Information Statement for Wage Earners and Self-Employed Individuals). It collects financial information from individuals to evaluate their ability to pay delinquent taxes. The form requests information about personal details, employment, other assets/income, bank accounts, investments, real estate, vehicles, and monthly income/expenses. It is used to determine an individual's total equity and allowable living expenses for establishing payment options.
This document is a Know Your Customer (KYC) form used to collect personal details and identification information from individuals applying for an LPG gas connection. The form collects details like name, date of birth, address, phone number, identity and address proof. It notes that fields marked with an asterisk are mandatory. It also provides instructions for filling the form, including acceptable forms of identity and address proof that must be provided. The applicant must declare that the information provided is true and accurate, and agrees that incorrect or incomplete information could result in discontinuation of gas supply or legal action. The dealer section confirms verification of original documents.
This document provides instructions for amending a Nevada state business license. It outlines the information needed to complete the amendment form, including the business name and ID number as registered with the Nevada Secretary of State. The amendment can be used to change the business name, contact information, physical address, or mailing address. The form must be signed by an authorized representative of the business and can be submitted by fax, email, or mail.
This document is a pre-approval form for opening a confidential bank account. It requests detailed personal and financial information about the primary account contact and their company in order to quickly process the application. This includes questions about identity, occupation, passport details, company activities and address, expected account transactions, and currency and debit card requirements. The form notes that an incomplete submission may delay the application process.
State/Congressional Officers 500 signatures
Office of the Secretary of State State Senate 100 signatures
Senatorial District Clerks State Representative 50 signatures
Representative District Clerks County Office (Probate Judge, Assistant Judges (Side Judges), State’s Attorney, Sheriff, High Bailiff) 100 signatures
County Clerk
https://www.sec.state.vt.us/elections/candidates.aspx
This document is a KYC upgrade form for Paytm Wallet. It requests mandatory personal information like name, date of birth, gender, photo, address, phone number, and email. It must be signed to declare that all information provided is true. Acceptable identity documents include Aadhar card, passport, driver's license, voter ID, and PAN card. Acceptable address proofs include these documents as well as utility bills, bank statements, job cards, and government letters. Original documents must be shown to the visiting representative for verification.
The document is a grant agreement from the U.S. Department of Labor to the Community College of Denver awarding them $17,256,881 through the Trade Adjustment Assistance Community College and Career Training Grants program. It provides instructions on accessing awarded funds through the Payment Management System and the Grantee Reporting System. It also outlines administrative cost limitations and incorporates the solicitation for grant applications into the agreement.
This document provides an overview and instructions for using the CATCH database, which tracks latent print case information. CATCH 2000 is the fourth version of the database, using Microsoft Access 97. It allows latent print technicians to easily retrieve case information, search for patterns in crimes, and consolidate multiple cases identified to the same suspect. The document describes the different sections and query features of the CATCH database to help administrators maintain and optimize it.
This 6-page document is an IRS Form 433-A (Collection Information Statement for Wage Earners and Self-Employed Individuals). It collects financial information from individuals to evaluate their ability to pay delinquent taxes. The form requests information about personal details, employment, other assets/income, bank accounts, investments, real estate, vehicles, and monthly income/expenses. It is used to determine an individual's total equity and allowable living expenses for establishing payment options.
This document is a Know Your Customer (KYC) form used to collect personal details and identification information from individuals applying for an LPG gas connection. The form collects details like name, date of birth, address, phone number, identity and address proof. It notes that fields marked with an asterisk are mandatory. It also provides instructions for filling the form, including acceptable forms of identity and address proof that must be provided. The applicant must declare that the information provided is true and accurate, and agrees that incorrect or incomplete information could result in discontinuation of gas supply or legal action. The dealer section confirms verification of original documents.
This document provides instructions for amending a Nevada state business license. It outlines the information needed to complete the amendment form, including the business name and ID number as registered with the Nevada Secretary of State. The amendment can be used to change the business name, contact information, physical address, or mailing address. The form must be signed by an authorized representative of the business and can be submitted by fax, email, or mail.
This document is a pre-approval form for opening a confidential bank account. It requests detailed personal and financial information about the primary account contact and their company in order to quickly process the application. This includes questions about identity, occupation, passport details, company activities and address, expected account transactions, and currency and debit card requirements. The form notes that an incomplete submission may delay the application process.
State/Congressional Officers 500 signatures
Office of the Secretary of State State Senate 100 signatures
Senatorial District Clerks State Representative 50 signatures
Representative District Clerks County Office (Probate Judge, Assistant Judges (Side Judges), State’s Attorney, Sheriff, High Bailiff) 100 signatures
County Clerk
https://www.sec.state.vt.us/elections/candidates.aspx
This document is a KYC upgrade form for Paytm Wallet. It requests mandatory personal information like name, date of birth, gender, photo, address, phone number, and email. It must be signed to declare that all information provided is true. Acceptable identity documents include Aadhar card, passport, driver's license, voter ID, and PAN card. Acceptable address proofs include these documents as well as utility bills, bank statements, job cards, and government letters. Original documents must be shown to the visiting representative for verification.
The document is a grant agreement from the U.S. Department of Labor to the Community College of Denver awarding them $17,256,881 through the Trade Adjustment Assistance Community College and Career Training Grants program. It provides instructions on accessing awarded funds through the Payment Management System and the Grantee Reporting System. It also outlines administrative cost limitations and incorporates the solicitation for grant applications into the agreement.
This document provides an overview and instructions for using the CATCH database, which tracks latent print case information. CATCH 2000 is the fourth version of the database, using Microsoft Access 97. It allows latent print technicians to easily retrieve case information, search for patterns in crimes, and consolidate multiple cases identified to the same suspect. The document describes the different sections and query features of the CATCH database to help administrators maintain and optimize it.
OnlineSEM.ru - Google Russia Stanislav VidyayevGooVape
The document discusses analytics practices for measuring the effectiveness of internet marketing in the Google Analytics system. It covers: 1) an overview of what Google Analytics is and how it works, 2) using reports in Google Analytics to categorize data, 3) managing accounts and using filters and profiles, and 4) integrating Google Analytics with AdWords to track advertising effectiveness. The goal is to help users better understand and utilize Google Analytics to improve marketing strategies.
This document provides a user's guide for generating EADDR statistics from Hyperion reports. It outlines the steps to navigate to reports in Hyperion, select corps, run queries, export results, convert the file format, import it into an Access database for processing, generate output spreadsheets, and troubleshoot potential issues. The process takes approximately 15 minutes to run queries in Hyperion and automatically generates statistics.
OnlineSEM.ru - Meta.ru - Особенности рекламных кампаний контекстной рекламы в...GooVape
IV бесплатный онлайн-семинар “Эффективный интернет-маркетинг для бизнеса” - Особенности рекламных кампаний контекстной рекламы в Украине; Анна Прокофьева, менеджер по контекстной рекламе интернет-компании МЕТА (Украина)
The document discusses the evolution of chromatin proteins and prediction of novel factors in chromatin dynamics. It summarizes that core chromatin components like histones are highly conserved, while transcription factors and chromatin proteins have expanded non-linearly. Analysis of protein domains and architectures can provide insights into evolutionary origins and predict novel functions. For example, analysis of MORC ATPases predicted a specific role in chromatin dynamics, and analysis of the DBC1 family predicted it may integrate regulatory inputs from NAD metabolites. Computational analysis suggests several unexplored chromatin biochemistries in model and non-model organisms.
OnlineSEM.ru 20.02.09 Анастасия Ильина, менеджер по работе с клиентами, компания AdLabs «Оценка эффективности контекстных рекламных кампаний. Сравнительный анализ сервисов веб-аналитики»
This document is a campaign finance report form for the specific-purpose committee called "Vote for McKinney's Future". It provides information such as the committee name and address, campaign treasurer name and address, report type and period covered, total political contributions and expenditures, and subtotals of amounts itemized on accompanying schedules. The form indicates the committee's purpose is to support a school district bond election and it discloses totals for monetary contributions, in-kind contributions, pledged contributions, loans, and expenditures.
This document is a funding request form for a neighborhood council. It requests information such as the requester's name, payment details, public benefit statement, and signatures from treasurer and board members. It also contains sections for the neighborhood council and city department to review and approve or deny the request.
This document contains forms from the Texas Ethics Commission related to campaign finance reporting for a candidate or officeholder. It includes information about the candidate/officeholder, treasurer, reporting period, election details, totals for contributions and expenditures, and an affidavit signed by the candidate/officeholder certifying the accuracy of the report.
The document defines key terms related to campaign finance reporting in Georgia including candidate, public official, election cycle, and qualifying officer. It provides information on filing requirements for various reports such as campaign contribution disclosure reports, personal financial disclosure statements, and two business day reports. Deadlines and grace periods for filing are specified. The roles of the declaration of intention and campaign committee registration are also summarized.
This document is a campaign finance report form for a specific-purpose political action committee called "Vote for McKinney's Future". It provides information about the committee such as the treasurer's contact information, the reporting period, and totals for contributions and expenditures. The form shows that the committee raised $17,260 in total contributions and spent $13,607.27 in total expenditures to support a May 7, 2016 McKinney Independent School District bond measure.
This document contains a registration form for membership in the Federal Government Employees Housing Foundation. The form requests personal information like name, father's name, CNIC number, address, contact details, employment details including department and rank. It also requires verification of employment details by the applicant's parent department. The guidelines section specifies the membership fees, plot sizes, eligibility criteria like minimum grade and that the applicant has not previously received a housing allotment. It lists the choice of locations and provides quotas and categories with corresponding fees and plot sizes.
Better Business Bureau Serving Greater Cleveland's September 2023 Market Monitor includes stories on aggressive ERC promoters, brushing scams that affect businesses, and how company's can apply to BBB's Spark Award.
Application for inclusion of name in electoral roll(form6)districtsasnagar
(1) The document is an application form (Form 6) for inclusion of a name in the electoral roll of an assembly/parliamentary constituency.
(2) It collects details of the applicant such as name, age, date of birth, place of birth, address, family members already in the electoral roll, and a declaration about citizenship and residence.
(3) Supporting documents that need to be attached include proof of identity, age, residence and relationship to other electors. Instructions are provided on how to fill the form correctly and where to submit it.
The document is a form for a UTI Mutual Fund unitholder to change their address and contact details in their folio. It requests the unitholder provide their folio number, old address, new address, and proofs of new address, old address, and identity. The unitholder must declare and sign the form, and submit copies of the address and identity proofs along with the original documents for verification.
This guide is published to assist people in understanding Vermont’s Campaign Finance statutes, but it is not a substitute for the statute. It is not possible in this guide to anticipate all factual situations that could arise under the campaign finance laws. You may contact the Secretary of State’s Office if you have questions about Vermont’s campaign finance law. However, you are advised to read the statutes carefully and consult an attorney when appropriate.
Vermont Secretary of State 128 State Street Montpelier, Vermont 05633-1101 802-828-2363 or 800-439-8683 sos.campaignfinance@sec.state.vt.us
Joe Tuman FPPC Form 460 10-1-14 to 10-18-14OakMayor2014
This document is a cover page and summary form for a campaign finance disclosure statement filed in California. It provides identifying information about the committee, treasurer, type of statement, and dates covered. The summary includes totals for monetary contributions received, cash payments made, and beginning and ending cash balances for the period. Key details like the committee name, treasurer, and dates covered are at the top, while totals for transactions are provided in columns for the current period and calendar year to date.
The document provides instructions for filing a US individual income tax return through Taxback.com. It outlines the following steps:
1. Print and complete required forms using the provided checklist to ensure all necessary documentation and information is included.
2. Scan/copy forms and supporting documents like W-2s and 1099s. Save files in PDF, JPG, or JPEG format under 2MB and email to the provided address.
3. Include identification documents like a US visa page or passport ID page along with a social security card copy.
The checklist details the forms, signatures, and documentation needed like employer information, program expenses, residency details, and payment documents to fully complete the tax
This document is an application for a GE Capital Retail Bank credit card. It requests personal information from applicants such as name, address, social security number, income, and employment details. If applying jointly, it also requests the same information for a joint applicant. Applicants must sign that they agree to the terms of the credit card account agreement, which includes interest rates and fees. The document provides details for validating the applicants' identification for the application process.
This document is an application form for membership to the Jersey Chamber of Commerce for 2015/16. It requests company details, contact information for the primary representative, a brief business description, consent for how the applicant's information will be used, membership category based on employee count, industry sector, and optional additional representative contact details. Membership fees vary based on employee count.
This document is a membership registration form for WCM777. It collects information such as the applicant's name, contact details, sponsor details, payment method and amount, and requires the applicant's signature to agree to the company's policies. The form gathers new member information including name, username, contact information, ID, email, address, distributor type as either an individual or company, and any notes.
This document describes the services of a private equity firm called Funding Merchant Source. It provides business financing to companies and has funded over $140 million for over 2000 businesses since 2009. It can offer financing options more flexibly than banks for businesses that need money to grow, expand, or have temporary cash flow needs. Funding is provided quickly, within 48 hours in most cases, with flexible repayment plans tailored to the business's operations.
OnlineSEM.ru - Google Russia Stanislav VidyayevGooVape
The document discusses analytics practices for measuring the effectiveness of internet marketing in the Google Analytics system. It covers: 1) an overview of what Google Analytics is and how it works, 2) using reports in Google Analytics to categorize data, 3) managing accounts and using filters and profiles, and 4) integrating Google Analytics with AdWords to track advertising effectiveness. The goal is to help users better understand and utilize Google Analytics to improve marketing strategies.
This document provides a user's guide for generating EADDR statistics from Hyperion reports. It outlines the steps to navigate to reports in Hyperion, select corps, run queries, export results, convert the file format, import it into an Access database for processing, generate output spreadsheets, and troubleshoot potential issues. The process takes approximately 15 minutes to run queries in Hyperion and automatically generates statistics.
OnlineSEM.ru - Meta.ru - Особенности рекламных кампаний контекстной рекламы в...GooVape
IV бесплатный онлайн-семинар “Эффективный интернет-маркетинг для бизнеса” - Особенности рекламных кампаний контекстной рекламы в Украине; Анна Прокофьева, менеджер по контекстной рекламе интернет-компании МЕТА (Украина)
The document discusses the evolution of chromatin proteins and prediction of novel factors in chromatin dynamics. It summarizes that core chromatin components like histones are highly conserved, while transcription factors and chromatin proteins have expanded non-linearly. Analysis of protein domains and architectures can provide insights into evolutionary origins and predict novel functions. For example, analysis of MORC ATPases predicted a specific role in chromatin dynamics, and analysis of the DBC1 family predicted it may integrate regulatory inputs from NAD metabolites. Computational analysis suggests several unexplored chromatin biochemistries in model and non-model organisms.
OnlineSEM.ru 20.02.09 Анастасия Ильина, менеджер по работе с клиентами, компания AdLabs «Оценка эффективности контекстных рекламных кампаний. Сравнительный анализ сервисов веб-аналитики»
This document is a campaign finance report form for the specific-purpose committee called "Vote for McKinney's Future". It provides information such as the committee name and address, campaign treasurer name and address, report type and period covered, total political contributions and expenditures, and subtotals of amounts itemized on accompanying schedules. The form indicates the committee's purpose is to support a school district bond election and it discloses totals for monetary contributions, in-kind contributions, pledged contributions, loans, and expenditures.
This document is a funding request form for a neighborhood council. It requests information such as the requester's name, payment details, public benefit statement, and signatures from treasurer and board members. It also contains sections for the neighborhood council and city department to review and approve or deny the request.
This document contains forms from the Texas Ethics Commission related to campaign finance reporting for a candidate or officeholder. It includes information about the candidate/officeholder, treasurer, reporting period, election details, totals for contributions and expenditures, and an affidavit signed by the candidate/officeholder certifying the accuracy of the report.
The document defines key terms related to campaign finance reporting in Georgia including candidate, public official, election cycle, and qualifying officer. It provides information on filing requirements for various reports such as campaign contribution disclosure reports, personal financial disclosure statements, and two business day reports. Deadlines and grace periods for filing are specified. The roles of the declaration of intention and campaign committee registration are also summarized.
This document is a campaign finance report form for a specific-purpose political action committee called "Vote for McKinney's Future". It provides information about the committee such as the treasurer's contact information, the reporting period, and totals for contributions and expenditures. The form shows that the committee raised $17,260 in total contributions and spent $13,607.27 in total expenditures to support a May 7, 2016 McKinney Independent School District bond measure.
This document contains a registration form for membership in the Federal Government Employees Housing Foundation. The form requests personal information like name, father's name, CNIC number, address, contact details, employment details including department and rank. It also requires verification of employment details by the applicant's parent department. The guidelines section specifies the membership fees, plot sizes, eligibility criteria like minimum grade and that the applicant has not previously received a housing allotment. It lists the choice of locations and provides quotas and categories with corresponding fees and plot sizes.
Better Business Bureau Serving Greater Cleveland's September 2023 Market Monitor includes stories on aggressive ERC promoters, brushing scams that affect businesses, and how company's can apply to BBB's Spark Award.
Application for inclusion of name in electoral roll(form6)districtsasnagar
(1) The document is an application form (Form 6) for inclusion of a name in the electoral roll of an assembly/parliamentary constituency.
(2) It collects details of the applicant such as name, age, date of birth, place of birth, address, family members already in the electoral roll, and a declaration about citizenship and residence.
(3) Supporting documents that need to be attached include proof of identity, age, residence and relationship to other electors. Instructions are provided on how to fill the form correctly and where to submit it.
The document is a form for a UTI Mutual Fund unitholder to change their address and contact details in their folio. It requests the unitholder provide their folio number, old address, new address, and proofs of new address, old address, and identity. The unitholder must declare and sign the form, and submit copies of the address and identity proofs along with the original documents for verification.
This guide is published to assist people in understanding Vermont’s Campaign Finance statutes, but it is not a substitute for the statute. It is not possible in this guide to anticipate all factual situations that could arise under the campaign finance laws. You may contact the Secretary of State’s Office if you have questions about Vermont’s campaign finance law. However, you are advised to read the statutes carefully and consult an attorney when appropriate.
Vermont Secretary of State 128 State Street Montpelier, Vermont 05633-1101 802-828-2363 or 800-439-8683 sos.campaignfinance@sec.state.vt.us
Joe Tuman FPPC Form 460 10-1-14 to 10-18-14OakMayor2014
This document is a cover page and summary form for a campaign finance disclosure statement filed in California. It provides identifying information about the committee, treasurer, type of statement, and dates covered. The summary includes totals for monetary contributions received, cash payments made, and beginning and ending cash balances for the period. Key details like the committee name, treasurer, and dates covered are at the top, while totals for transactions are provided in columns for the current period and calendar year to date.
The document provides instructions for filing a US individual income tax return through Taxback.com. It outlines the following steps:
1. Print and complete required forms using the provided checklist to ensure all necessary documentation and information is included.
2. Scan/copy forms and supporting documents like W-2s and 1099s. Save files in PDF, JPG, or JPEG format under 2MB and email to the provided address.
3. Include identification documents like a US visa page or passport ID page along with a social security card copy.
The checklist details the forms, signatures, and documentation needed like employer information, program expenses, residency details, and payment documents to fully complete the tax
This document is an application for a GE Capital Retail Bank credit card. It requests personal information from applicants such as name, address, social security number, income, and employment details. If applying jointly, it also requests the same information for a joint applicant. Applicants must sign that they agree to the terms of the credit card account agreement, which includes interest rates and fees. The document provides details for validating the applicants' identification for the application process.
This document is an application form for membership to the Jersey Chamber of Commerce for 2015/16. It requests company details, contact information for the primary representative, a brief business description, consent for how the applicant's information will be used, membership category based on employee count, industry sector, and optional additional representative contact details. Membership fees vary based on employee count.
This document is a membership registration form for WCM777. It collects information such as the applicant's name, contact details, sponsor details, payment method and amount, and requires the applicant's signature to agree to the company's policies. The form gathers new member information including name, username, contact information, ID, email, address, distributor type as either an individual or company, and any notes.
This document describes the services of a private equity firm called Funding Merchant Source. It provides business financing to companies and has funded over $140 million for over 2000 businesses since 2009. It can offer financing options more flexibly than banks for businesses that need money to grow, expand, or have temporary cash flow needs. Funding is provided quickly, within 48 hours in most cases, with flexible repayment plans tailored to the business's operations.
Dan Siegel FPPC Form 460 10-1-14 to 10-18-14OakMayor2014
This document is a campaign finance disclosure form for Dan Siegel for Mayor, 2014. It includes:
1) Contact information for the committee and treasurer.
2) A summary of contributions received and expenditures made in the reporting period, as well as current cash on hand.
3) Schedules attached providing more detail on contributions, expenditures, accrued expenses and loans.
Jean Quan FPPC Form 460 10-1-14 to 10-18-14OakMayor2014
This document is a cover page and form for a California campaign disclosure statement. It includes information such as the name and address of the committee, treasurer, controlled candidates, and dates covered by the statement. The main points are that it is a campaign disclosure statement for the Re-Elect Mayor Quan 2014 committee that covers the period from October 1, 2014 to October 18, 2014, and includes standard information about the committee, treasurer, and controlled candidates required as part of the state's campaign finance disclosure process.
This document appears to be a campaign finance report cover sheet for a candidate or officeholder. It includes information such as the filer's name and contact information, the campaign treasurer's name and contact information, details about the election and office sought, summary totals of contributions and expenditures, and a signed affidavit certifying the accuracy of the report. The cover sheet provides essential identifying and summary financial information for a campaign finance filing as required by the state of Texas.
This document contains an application form for a Pag-IBIG Loyalty Card Plus. The form requests personal details such as name, address, contact information, employment details, and membership category. It provides instructions for completing the form, including using block letters and indicating mandatory fields. The form also includes agreements for authorizing Pag-IBIG to use the applicant's information and share it with partners.
Youngest c m in India- Pema Khandu BiographyVoterMood
Pema Khandu, born on August 21, 1979, is an Indian politician and the Chief Minister of Arunachal Pradesh. He is the son of former Chief Minister of Arunachal Pradesh, Dorjee Khandu. Pema Khandu assumed office as the Chief Minister in July 2016, making him one of the youngest Chief Ministers in India at that time.
Essential Tools for Modern PR Business .pptxPragencyuk
Discover the essential tools and strategies for modern PR business success. Learn how to craft compelling news releases, leverage press release sites and news wires, stay updated with PR news, and integrate effective PR practices to enhance your brand's visibility and credibility. Elevate your PR efforts with our comprehensive guide.
13062024_First India Newspaper Jaipur.pdfFIRST INDIA
Find Latest India News and Breaking News these days from India on Politics, Business, Entertainment, Technology, Sports, Lifestyle and Coronavirus News in India and the world over that you can't miss. For real time update Visit our social media handle. Read First India NewsPaper in your morning replace. Visit First India.
CLICK:- https://firstindia.co.in/
#First_India_NewsPaper
Here is Gabe Whitley's response to my defamation lawsuit for him calling me a rapist and perjurer in court documents.
You have to read it to believe it, but after you read it, you won't believe it. And I included eight examples of defamatory statements/
1. CERTIFICATION
FORM 2013
If you are running in the 2013 elections and you wish to participate
in the Campaign Finance Program and be eligible to receive public
funds, the Certification form must be filed no later than June 10, 2013.
Late or incomplete Certifications will not be accepted. Metered mail
and other mail without a verifiable postmark will be presumed to have
been mailed three days prior to receipt by the CFB.
File this form to
become eligible to
receive public funds
2. 2013 CERTIFICATION FORM
You must file this form with the New York City Campaign Finance Board (“CFB”) to become a participant in the
Campaign Finance Program (“Program”).
THE DEADLINE TO FILE THIS FORM IS JUNE 10, 2013.
If you are running in the 2013 elections and wish to participate in the Program and be eligible to receive public
funds, the Certification form must be filed no later than June 10, 2013. Late or incomplete Certifications will not
be accepted. Limited participants are required to file the Certification with a cover letter stating the candidate
chooses to be a limited participant. Metered mail and other mail without a verifiable postmark will be presumed
to have been mailed three days prior to receipt by the CFB.
IMPORTANT INFORMATION—PLEASE READ
Complete the entire Certification. Enter “N/A” to indicate items which do not apply. All mandatory fields
have been marked with an “*”. All pages must be submitted by mail or hand-delivery with original
signatures of the candidate and treasurer. Incomplete or illegible forms will not be accepted. Any
changes to the information provided require an amendment to the Certification. Contact the Candidate
Services Unit at (212) 306-7100 for more information.
Communications, both written and oral, will be directed to the candidate’s, treasurer’s, and/or principal
committee’s address, telephone number, and/or email address.
You must notify the CFB of any changes to the information.
C-Access is the CFB’s interactive website for campaigns, providing secure online access to C-SMART (Candidate
Software for Managing and Reporting Transactions), campaign information, and compliance matters. If you have
not previously registered with the CFB for the current election cycle using a Filer Registration form, a C-Access
account username and password will be sent to the candidate, treasurer, and voter guide liaison once the
Certification has been filed.
C-SMART is the CFB’s proprietary web-based software that campaigns are required to use to enter all financial
transactions and electronically submit disclosure statements to the CFB and the New York State Board of
Elections (NYS BOE). It is mandatory that email addresses be provided for both the candidate and treasurer
as part of your registration with the CFB.
Campaign-specific usernames, passwords, and an encryption key will be issued to both the candidate and
treasurer upon initial registration.
To protect your privacy, the CFB will not provide specific information related to your campaign to any individual
or entity not listed on this Certification unless such disclosure is required pursuant to the Freedom of Information
Law, Article 6 of the Public Officers Law (“FOIL”), or other law.
Reminder: Public servants are prohibited from using government resources for their campaigns. Do not list any
government phone, fax, email, or address as campaign contact information on this form. Government resources
may only be included under “candidate employment” or “treasurer employment” sections (if applicable).
New York City Campaign Finance Board
40 Rector Street, 7th Floor, NewYork, NY 10006 • Tel.: (212) 306-7100 • Fax: (212) 306-7143/44
Website: www.nyccfb.info • E-mail: CSUmail@nyccfb.info
3. 2013 CERTIFICATION FORM
1. CANDIDATE NAME AND HOME ADDRESS
Enter the candidate’s name, address, telephone numbers, and email address.
Note: the candidate’s home address is an address to which legal notices may be sent. You must promptly notify the
CFB of any changes.
MR. MRS. MS. LAST* FIRST* M.I.
STREET ADDRESS* APARTMENT/SUITE/FLOOR
CITY* STATE* ZIP CODE* DAY TELEPHONE*
( )
EVENING TELEPHONE
( )
FAX
( )
EMAIL ADDRESS*
2. CANDIDATE EMPLOYMENT
Enter the candidate’s employment information.
EMPLOYER NAME
STREET ADDRESS APARTMENT/SUITE/FLOOR
CITY STATE ZIP CODE
TELEPHONE
( )
FAX
( )
3. OFFICE SOUGHT
Enter the office sought, borough or Council district #, and party registration.
OFFICE BOROUGH OR COUNCIL DISTRICT #
PARTY REGISTRATION (OPTIONAL)
4. PRINCIPAL COMMITTEE
Enter the committee name, address, New York State Board of Elections (NYS BOE) Filer ID Number, date opened
with the NYS BOE, and other information for the principal committee. The CFB advises against using a P.O. Box for
your committee address. Candidates must authorize and use only one political committee to make expenditures,
raise contributions, and receive public matching funds for the 2013 elections. This political committee is the
candidate’s “principal committee.” It cannot have been authorized nor used for any other election, or be the
authorized committee for any other candidate.
Note: the committee address is an address to which legal notices may be sent. You must promptly notify the CFB
of any changes.
COMMITTEE NAME* NYS BOE FILER ID NUMBER*
STREET ADDRESS* APARTMENT/SUITE/FLOOR NYS BOE REGISTRATION DATE*
CITY* STATE* ZIP CODE* DAY TELEPHONE*
( )
EVENING TELEPHONE
( )
FAX
( )
EMAIL ADDRESS*
WEBSITE ADDRESS(ES)*
CFB USE ONLY
CFB USE ONLY
CFB USE ONLY
New York City Campaign Finance Board
40 Rector Street, 7th Floor, NewYork, NY 10006 • Tel.: (212) 306-7100 • Fax: (212) 306-7143/44
Website: www.nyccfb.info • E-mail: CSUmail@nyccfb.info
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4. MAILING ADDRESS (IF DIFFERENT)
If the principal committee’s address is different from the mailing address, enter the mailing address here. This
mailing address will be used for all notices sent to the principal committee.
COMPANY OR BUILDING NAME; P.O. BOX (IF APPLICABLE)
STREET ADDRESS APARTMENT/SUITE/FLOOR
CITY STATE ZIP CODE
5. PREVIOUS ELECTIONS
Enter the previous election(s), if any, in which the candidate sought nomination for election, or election, to public
office or a party position.
Have you previously been a candidate for any elective office or political party position?* YES NO
If yes, please specify your most recent candidacies below:
DATE OF ELECTION (MONTH/YEAR) OFFICE OR PARTY POSITION SOUGHT DISTRICT PARTY PRIMARY ENTERED
6. TREASURER NAME AND HOME ADDRESS
Enter the treasurer’s name, address, telephone numbers, and email address.
Note: the treasurer’s home address is an address to which legal notices may be sent. You must promptly notify the
CFB of any changes.
MR. MRS. MS. LAST* FIRST* M.I.
STREET ADDRESS* APARTMENT/SUITE/FLOOR
CITY* STATE* ZIP CODE* DAY TELEPHONE*
( )
EVENING TELEPHONE
( )
FAX
( )
EMAIL ADDRESS*
7. TREASURER EMPLOYMENT
Enter the treasurer’s employment information.
EMPLOYER NAME
STREET ADDRESS APARTMENT/SUITE/FLOOR
CITY STATE ZIP CODE
TELEPHONE
( )
FAX
( )
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5. 8. SCHEDULE OF ACCOUNTS
List all bank accounts opened by your committee and indicate the type and purpose of the account.
Note: a “segregated account” is exclusively for depositing non-matchable contributions for the purposes of: making
contributions to other political committees; making loans to or spending for other candidates, political clubs, or
political committees; payments of expenses for or debts from past elections; and transfers to committees not
involved in the participant’s current election.
PRIMARY BANK ACCOUNT TYPE OF ACCOUNT (SELECT ONE)*
CHECKING
SAVINGS
MONEY MARKET
OTHER (SPECIFY)
PURPOSE OF ACCOUNT (SELECT ONE)
2013 PRIMARY/GENERAL ELECTION
2013 ELECTIONS–SEGREGATED
OTHER (SPECIFY)
BANK/DEPOSITORY NAME*
CITY* STATE* ZIP CODE*
ACCOUNT NUMBER*
ACCOUNT NAME (IF ANY)
DATE OPENED*
DATE CLOSED CURRENT BALANCE*
$
MONTH* DAY* YEAR*
SECONDARY BANK ACCOUNT TYPE OF ACCOUNT (SELECT ONE)
CHECKING
SAVINGS
MONEY MARKET
OTHER (SPECIFY)
PURPOSE OF ACCOUNT (SELECT ONE)
2013 PRIMARY/GENERAL ELECTION
2013 ELECTIONS–SEGREGATED
OTHER (SPECIFY)
BANK/DEPOSITORY NAME
CITY STATE ZIP CODE
ACCOUNT NUMBER
ACCOUNT NAME (IF ANY)
DATE OPENED
DATE CLOSED CURRENT BALANCE
$
MONTH DAY YEAR
Attach additional form page(s) if the principal committee has more than one (1) additional bank account.
DIRECT DEPOSIT OF PUBLIC FUNDS
In order to receive public funds by direct deposit, you must list your ABA/Routing Number found on your committee
check and attach a VOIDED check from your principal committee’s checking account below. Starter checks will not
be accepted.
ABA/ROUTING NUMBER*
2013 Election Cycle Checking Account (for Direct Deposit of Public Funds only)
Friends of Jane Henley
44-22 Roosevelt Avenue, Ste 504
Jackson Heights, NY 11372
Pay to the order of:
ENTER YOUR PRINCIPAL COMMITTEE’S
ABA/ROUTING NUMBER
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6. 9. UNIQUE MERCHANT ACCOUNTS
If you accept credit card contributions, you must disclose the acquiring bank’s name and your committee’s own
unique merchant account numbers.
ACQUIRING BANK’S NAME COMMITTEE’S UNIQUE MERCHANT ACCOUNT NUMBER
ACQUIRING BANK’S NAME COMMITTEE’S UNIQUE MERCHANT ACCOUNT NUMBER
10. CAMPAIGN MANAGER (IF APPLICABLE)
If your campaign manager will function as a liaison to the CFB, enter the manager’s name, address, telephone
numbers, and email address.
MR. MRS. MS. LAST FIRST M.I.
STREET ADDRESS APARTMENT/SUITE/FLOOR
CITY STATE ZIP CODE DAY TELEPHONE
( )
EVENING TELEPHONE
( )
FAX
( )
EMAIL ADDRESS
11A. CAMPAIGN LIAISON (IF APPLICABLE)
If you would like a person to function as a liaison to the CFB in addition to the candidate, treasurer, and campaign
manager or consultant (if applicable), enter the person’s name, address, telephone numbers, and email address.
MR. MRS. MS. LAST FIRST M.I.
STREET ADDRESS APARTMENT/SUITE/FLOOR
CITY STATE ZIP CODE DAY TELEPHONE
( )
EVENING TELEPHONE
( )
FAX
( )
EMAIL ADDRESS
11B. VOTER GUIDE LIAISON (OPTIONAL)
You may designate an individual to serve as your Voter Guide liaison. This person will be provided access to the
Voter Guide Submission application found in C-Access and be able to help draft and edit your Voter Guide profile
and Video Voter Guide script. (The candidate, treasurer, and any other campaign staff for whom you request a
C-Access account will be able to access the Voter Guide Submission application.)
Note: only the candidate is able to submit the profile and script to the CFB.
MR. MRS. MS. LAST FIRST M.I.
STREET ADDRESS APARTMENT/SUITE/FLOOR
CITY STATE ZIP CODE DAY TELEPHONE
( )
EVENING TELEPHONE
( )
FAX
( )
EMAIL ADDRESS
12. CAMPAIGN CONSULTANT (IF APPLICABLE)
If you have retained a consultant for the purpose of complying with the Program, enter the consultant’s name,
address, telephone numbers, and email address.
MR. MRS. MS. LAST FIRST M.I.
STREET ADDRESS APARTMENT/SUITE/FLOOR
CITY STATE ZIP CODE DAY TELEPHONE
( )
EVENING TELEPHONE
( )
FAX
( )
EMAIL ADDRESS
CONSULTANT ENTITY NAME (IF APPLICABLE)
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7. 13. ADDITIONAL INDIVIDUAL WITH SIGNIFICANT MANAGERIAL CONTROL (OPTIONAL)
The Board’s Rules require that participating candidates, their treasurers, campaign managers, or “persons with
significant managerial control over a campaign” attend a training provided by the CFB concerning compliance with
the requirements of the Program and use of its software.
If someone other than the candidate, treasurer, or campaign manager has “significant managerial control” over the
campaign, list that person’s name and contact information. Note: the individual listed below cannot be the campaign
consultant previously listed in section 12 of this Certification.
MR. MRS. MS. LAST FIRST M.I.
STREET ADDRESS APARTMENT/SUITE/FLOOR
CITY STATE ZIP CODE DAY TELEPHONE
( )
EVENING TELEPHONE
( )
FAX
( )
EMAIL ADDRESS
14. CONTACT ORDER
Select the order in which you would like the CFB to contact representatives of your campaign. We try to contact
your representatives in the order selected, however if we are unable to reach the individual, we will call or email
the candidate and treasurer directly. Additionally, certain written notices will be sent directly to the candidate and
treasurer’s home address notwithstanding the order requested.
Candidate should be contacted:* First Second Third Fourth Fifth
Treasurer should be contacted:* First Second Third Fourth Fifth
Campaign Manager should be contacted: First Second Third Fourth Fifth N/A
Liaison should be contacted: First Second Third Fourth Fifth N/A
Consultant should be contacted: First Second Third Fourth Fifth N/A
15. OTHER AUTHORIZED COMMITTEES
Complete this section if the candidate has committees (including any political action committees) that are active and
file disclosure statements with the New York State Board of Elections (NYS BOE) or Federal Election Commission
(FEC). Please indicate the name of the committee, the date of the last election in which the committee was involved,
office sought, treasurer’s information, date opened with the NYS BOE or FEC, and whether the committee is a joint
committee.
Remember, only the principal committee can be used for the 2013 elections.
COMMITTEE NAME LAST ELECTION DATE & OFFICE
TREASURER’S LAST NAME TREASURER’S FIRST NAME
DATE OPENED WITH NYS BOE OR FEC IF JOINT COMMITTEE, LIST OTHER CANDIDATE(S)
DAY TELEPHONE
( )
EVENING TELEPHONE
( )
COMMITTEE NAME LAST ELECTION DATE & OFFICE
TREASURER’S LAST NAME TREASURER’S FIRST NAME
DATE OPENED WITH NYS BOE OR FEC IF JOINT COMMITTEE, LIST OTHER CANDIDATE(S)
DAY TELEPHONE
( )
EVENING TELEPHONE
( )
Attach additional form pages if the candidate has additional authorized committees.
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8. 5 1
16. CANDIDATE VERIFICATION
The candidate must read and initial each clause and sign the Candidate Verification. The candidate’s signature must
be notarized.
I hereby verify that I have not accepted, and I agree not to accept, any contribution or contributions
from any one contributor for the 2013 elections that exceed(s) the applicable contribution limit set forth
in Section 3-703(1)(f) and (h) of the New York City Administrative Code (“Administrative Code”); that I
have not used, and I agree not to use, my personal funds or property (or that of my spouse, domestic
partner, or unemancipated children) for these elections, except as contributions that do not exceed the
limit set forth in Section 3-703(1)(h) of the Administrative Code; that I have not made, and I agree not to
make, expenditures in excess of the expenditure limits applicable to the office I am seeking, pursuant
to Section 3-706 of the Administrative Code; that I have not accepted and agree to not accept directly
or indirectly any contributions from a corporation or from a political committee not registered with the
CFB; that I have not accepted any contributions from a partnership, LLC, or LLP since January 1, 2008,
and will not do so; and that I agree to abide by all other applicable requirements of Title 3, Chapter 7
of the Administrative Code (the “New York City Campaign Finance Act” or the “Act”) and the Campaign
Finance Board Rules (the “Rules”), including requirements for campaign finance disclosure statements
and recordkeeping. initial here*
I hereby designate the authorized committee noted in Section 4 of this document to be my principal
committee for the 2013 elections. The principal committee will submit the campaign finance disclosure
statements required by the Act and will receive all public funds payments for which I qualify in these
elections. The principal committee (i) is the only committee authorized by me to aid or otherwise
take part in the elections covered by this Certification; (ii) is not an authorized committee of any other
candidate; and (iii) has not been, is not, and will not be, authorized or otherwise active for any elections
other than the elections covered by this Certification. I understand that the use of an entity other than
the designated principal committee to aid or otherwise take part in the 2013 elections is a violation
of the Act and will trigger the application to such entity of all provisions of the Act governing principal
committees. initial here*
I understand that I am responsible for reading, understanding, and knowing the contents of the Act and
the Rules. I also understand that I, the principal committee I authorize, my treasurer, and my agents are
required to abide by the terms and conditions of the Act and the Rules applicable to the 2013 elections,
even if amended after I sign this, regardless whether I: meet the requirements of law to have my name
appear on the official ballot for those elections; or meet the threshold for eligibility for public funds; or
accept public funds; or am otherwise not eligible to receive public funds. initial here*
I understand that this Certification is a condition for qualifying to receive public funds in these elections
and that other conditions specified in the Act must be satisfied before I may receive public funds
pursuant to the Act. initial here*
I understand that my home address, the principal committee address and the treasurer’s home address,
and email addresses as provided above in Sections 1, 4, and 6 are the addresses to which legal notices,
including correspondence and legal papers, will be sent. I further understand that if any of these
addresses change, I must promptly notify the CFB, in writing, of the change. initial here*
I understand that by providing a voided check in Section 8, I am authorizing the CFB to deposit any
public funds payments my campaign is eligible to receive directly into the indicated checking account.
I also grant authorization to the CFB for the full or partial reversal of any deposits to this account in the
event that the deposit was made partly or entirely in error. initial here*
I understand that failure to abide by the requirements of the Act or Rules may result in the imposition
of such penalties as are provided in Section 3-711 of the Administrative Code and other applicable law
or rules. The Act empowers the Board to assess a civil penalty of up to $10,000 for any violation, which
may be assessed jointly and severally against me, the principal committee I designate for the 2013
elections, the treasurer of that committee, and any other of my agents. I further understand that the Act
allows the Board to assess civil penalties exceeding $10,000 against my principal committee and me
for the 2013 elections for failing to participate in the post-election audit process and for spending limit
violations. In particular, the Board may assess a penalty of up to 10% of public funds received by my
campaign for failing to participate in the post-election audit process, and, for spending limit violations, a
civil penalty of up to three times the amount the spending limit has been exceeded. I also acknowledge
that the committee I designate for the 2013 elections and I may be jointly and severally liable for the
repayment of public funds to the Board. initial here*
9. I understand that if the campaign exceeds the applicable expenditure limit under the Act, in addition
to any penalties that may be assessed, the Board may require that all public funds received by the
campaign be returned to the Board, and that the campaign may not be eligible to receive any additional
public funds for the 2013 elections. I further understand that if the campaign is required to return any
public funds for exceeding the expenditure limit, or for any other reason, the principal committee I
designate for the 2013 elections and I may be jointly and severally liable for such repayment. initial here*
I understand that financial control over the campaign is ultimately my responsibility. If any campaign
expenditures are illegal, improper, or not in furtherance of my nomination or election, my principal
committee and I may be required to return the amount of such expenditures to the Board. In addition,
if the campaign does not submit documentation for an expenditure, such expenditure may not be
considered a “qualified campaign expenditure.” Therefore, I understand that my campaign must follow
published Board guidelines and procedures, employ trained staff, and implement standard financial
controls and procedures. initial here*
I understand that the CFB will issue usernames and passwords to my treasurer and I to be used to
submit disclosure statements, and that only my treasurer and I may complete the disclosure statement
process and submit disclosure statements to the CFB. I further understand that my treasurer and I will
be given a single encryption key in order to access campaign data entered using C-SMART. Without
the encryption key, we will not be able to access our campaign’s financial data because it is kept
in encrypted form. I further understand that my treasurer or I may change the initial encryption key
provided by the CFB. If my treasurer or I change the initial encryption key and lose that new key, all
data previously entered will be inaccessible. I understand that the CFB will not be able to recover the
encryption key or any of our campaign data.
initial here*
I verify that the information on this document is true and complete to the best of my knowledge and
belief. I understand that intentionally or knowingly making a false statement, including but not limited to
in the form of an electronic submission, or intentionally or knowingly violating any provision of the Act, is
a Class A misdemeanor pursuant to Section 3-711(3) of the Administrative Code. initial here*
I understand that knowingly making a false written statement, including but not limited to in the form
of an electronic submission, is a Class A misdemeanor pursuant to New York State Penal Law Section
210.45. initial here*
I understand that knowingly offering false written information, including but not limited to in the form of
an electronic submission, with the belief that it will become a part of the records of a public office and
with the intent to defraud, is a Class E felony pursuant to New York State Penal Law Section 175.35. initial here*
SWORN TO BEFORE ME THIS
CANDIDATE SIGNATURE*
day of
, 20
NOTARY PUBLIC*
10. 17. TREASURER VERIFICATION
The treasurer must read and initial each clause and sign the Treasurer Verification. The treasurer’s signature must
be notarized.
As treasurer of the principal committee listed in Section 4 of this document, I hereby verify that I am
treasurer of the only committee authorized by the candidate that will be involved in the 2013 elections.
I understand that the use of an entity other than the designated principal committee to aid or otherwise
take part in the 2013 elections is a violation of Title 3, Chapter 7 of the New York City Administrative
Code (the “New York City Campaign Finance Act” or the “Act”) and will trigger the application to such
entity of all provisions of the Act governing principal committees. initial here*
I hereby verify that the principal committee has not accepted and agrees not to accept any contribution
or contributions from any one contributor for the 2013 elections that exceed(s) the applicable
contribution limit set forth in Section 3-703(1)(f) and (h) of the New York City Administrative Code (the
“Administrative Code”); that the committee has not made, and agrees not to make, expenditures in
excess of the expenditure limits applicable to the office the candidate is seeking, pursuant to Section
3-706 of the Administrative Code; that the committee has not accepted and agrees to not accept
directly or indirectly any contributions from a corporation or a political committee not registered with
the CFB; that the committee has not accepted any contributions from a partnership, LLC, or LLP since
January 1, 2008, and will not do so; and that I, on behalf of the committee, agree to abide by all other
applicable requirements of the Act and the Campaign Finance Board Rules (the “Rules”), including
requirements for campaign finance disclosure statements and recordkeeping. initial here*
I understand that I am responsible for reading, understanding, and knowing the contents of the Act and
the Rules. I also understand that I, the candidate, the principal committee authorized by the candidate,
and the candidate’s agents, are required to abide by the terms and conditions of the Act and the Rules
applicable to the 2013 elections, even if amended after I sign this, regardless whether the candidate:
meets the requirements of law to have his or her name appear on the official ballot for these elections;
or meets the threshold for eligibility for public funds; or accepts public funds; or is otherwise not eligible
to receive public funds. initial here*
I understand that the candidate’s home address, the principal committee address and my home
address, and email addresses as provided above in Sections 1, 4, and 6 are the addresses to which
legal notices, including correspondence and legal papers, will be sent. I further understand that if any of
these addresses change, I am responsible for promptly notifying the CFB, in writing, of the change. initial here*
I understand that by providing a voided check in Section 8, I am authorizing the CFB to deposit any
public funds payments the campaign is eligible to receive directly into the indicated checking account.
I also grant authorization to the CFB for the full or partial reversal of any deposits to this account in the
event that the deposit was made partly or entirely in error. initial here*
I understand that failure to abide by the requirements of the Act or Rules may result in the imposition
of such penalties as are provided in Section 3-711 of the Administrative Code and other applicable law
or rules. The Act empowers the Board to assess a civil penalty of up to $10,000 for any violation, which
may be assessed jointly and severally against me, the candidate, the principal committee designated
by the candidate for the 2013 elections, and any other agents of the candidate. I acknowledge that I
am jointly and severally liable for the first $10,000 of any civil penalty assessed against the campaign,
including penalties for failing to participate in the post-election audit process and for spending limit
violations. initial here*
I understand that if the campaign exceeds the applicable expenditure limit under the Act, in addition
to any penalties that may be assessed, the Board may require that all public funds received by the
campaign be returned to the Board, and that the campaign may not be eligible to receive any additional
public funds for the 2013 elections. initial here*
11. I understand that the CFB will issue usernames and passwords to the candidate and I to be used to
submit disclosure statements, and that only the candidate and I may complete the disclosure statement
process and submit disclosure statements to the CFB. I further understand that the candidate and I will
be given a single encryption key in order to access campaign data entered using C-SMART. Without
the encryption key, we will not be able to access our campaign’s financial data because it is kept in
encrypted form. I further understand that the candidate or I may change the initial encryption key
provided by the CFB. If the candidate or I change the initial encryption key and lose that new key, all
data previously entered will be inaccessible. I understand that the CFB will not be able to recover the
encryption key or any of our campaign data. initial here*
I verify that the information on this document is true and complete to the best of my knowledge and
belief. I understand that intentionally or knowingly making a false statement, including but not limited to
in the form of an electronic submission, or intentionally or knowingly violating any provision of the Act, is
a Class A misdemeanor, pursuant to Section 3-711(3) of the Administrative Code. initial here*
I understand that knowingly making a false written statement, including but not limited to in the form
of an electronic submission, is a Class A misdemeanor pursuant to New York State Penal Law Section
210.45. initial here*
I understand that knowingly offering false written information, including but not limited to in the form of
an electronic submission, with the belief that it will become a part of the records of a public office and
with the intent to defraud, is a Class E felony pursuant to New York State Penal Law Section 175.35. initial here*
SWORN TO BEFORE ME THIS
TREASURER SIGNATURE*
day of
, 20
NOTARY PUBLIC*
TOTAL NUMBER OF PAGES SUBMITTED
(INCLUDING THE CANDIDATE AND TREASURER VERIFICATIONS)