Form Cf-03 Committee Authorization Status - New York State Board Of Elections
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2CF-03
COMMITTEE AUTHORIZATION STATUS
NEW YORK STATE BOARD OF ELECTIONS
Section 14-112 of NYS Election Law
THIS FORM MUST CONTAIN ORIGINAL SIGNATURES IN INK AND BE COMPLETED IN FULL
Please check one:
[ ] New Form
[ ] Amended Form (provide Filer ID#):
NAME OF COMMITTEE
:
For Acronyms (see instructions):
A.
List in this section those candidates who have authorized your committee to aid or take part in their election or nomi-
nation (other than by making contributions). Provide name, office and district. (Attach additional sheets if necessary.)
1. Date of Election:
Office/ District:
Candidate’s Full Name:
Candidate’s Residential Address: _________________________________________________________________Apartment # ___________
2. Date of Election:
Office/ District:
Candidate’s Full Name:
Candidate’s Residential Address: _________________________________________________________________Apartment # ___________
3. Date of Election:
Office/ District:
Candidate’s Full Name:
Candidate’s Residential Address: _________________________________________________________________Apartment # ___________
B.
List those candidates for whom your committee is aiding or taking part in their election or nomination (other than by
making contributions) but who have not authorized your committee to do so. (Attach additional sheets if necessary.)
1. Date of Election:
Office/ District:
Candidate’s Full Name:
2. Date of Election:
Office/ District:
Candidate’s Full Name:
3. Date of Election:
Office/ District:
Candidate’s Full Name:
VERIFICATION STATEMENT BY TREASURER
I
being duly sworn, depose and say that the information provided
______________________________________________________________,
(Print Full Name of Treasurer)
on this form is complete, true and correct.
Sworn to before me this
day
____________________
Signature of Committee Treasurer
of
, 20
_________________________________
____
Residential Address
___________________________________________
(Notary Public or Commissioner of Deeds)
Contact Phone Number
CF-03 03/14
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