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Whe SEEC FORM 1 retace STATEELECTIONS ENFoncEMENT comnasston | ME € ch 11 Tit bid Registration by Candidate rm \ Rose Septem 2016 avd REGSTEATON TIP [DELNGHONDAT aang [ENING iiss CoAmenimen nlesl2oia Danae y ORRIGEORFORTTONSOTNT CoRRICT NTE Voun Cl SPAR AMATERTION Republican Denweraio Other a) CaNDIDATENANE Wanves Q [Gree CANDIDATE RESIDENCE ADDRESS CANDIDATE MATING ADRESS ae 1B id Waurake Qd Danser u oS. 244. 2z5S| meyaiea @ acl.cow ic BESTGNATION OF Cm ATGN FUNDING SOURCE (Cheek ono) GA, Lam forming candidate committe and I am required to file a Candidate Committee Registration Statement Goto Form 18 and complete pages 2 and 3 — Conidae Regaration Steen CIR. Tam exempt from forming a candidate committe and Lam filing a Certification of Bemption fiom Forming a Candidate Comsnites. Got Form 1 and complete page 4— Corifeaion of Esomption from Forming Conder Commit. Important Notice Fallre of candidate co complet hs page gether with ether Form 1A, “Reparation ‘t Candidate Committe,” or Form IB “Exempton from Forming Candidate Commits” within 10 days ‘ot becoming candidate wil subject the candidate to mandatory S100 late ing fee. See Selon 9.6230), Connecticut General tatutes Mating fe anc on form ay ont ou rnin pointing intel inpriomen fr poe ear eran poo ows dts eh SEEC FORM 1A ‘STATE ELECTIONS ENFORCEMENT COMMISSION Candidate Committee Registration Statement Revs Soptoma 201, THGIATION TYRE [ CANDDATENANT inet CAnednert Janvee Q Greate Guegier 4 73 CONRUTRE ADDRESS a COMDATETER EWA ADDRESS WHDSTTE, cea NE Relre-* = Zarlneck 777A RETDENCE ADDRES aca SORE MATTING ADDRESS wa BA Belen’ Cicecte #2 Qaaoe-4y ct [Guerd 2H TREASURER EAI ADDRESS 3-190 ucts ¢ okt ne a DART RENURER TONE a DER PASTURE RESIDENCE ADDRESS [a DER TREASURER MAILING ADDRESS Wain [aR TRRAURAN TALRRTONE | SE DEPUTY TAENGURER ENT ADDRES ic DRFOSITORY INSTITUTION NAME Bauwng> Bonk

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