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2. Committee Name
4. What changes need to be reported? Check all that apply and fill in the corresponding section on form.

   1. Committee Name
   2. Registered Agent's Address,Phone or Email

   1. Replacement Registered Agent
   2. Financial Institution Information
6. Name of Person Acting as Registered Agent (Treasurer)
8. Is this a Replacement Registered Agent?

   1. Yes

   1. No
10. Physical Address
12. City
13. State
14. Zip
16. Mailing Address
18. City
19. State
20. Zip
22. Phone Number
23. Email
25. Financial Institution Name
27. Is this a Replacement Financial Institution?

    1. Yes

    1. No
29. Institution Physical Address
31. Registered Agent's Signature*
32. Date*
    Date
34. Candidate Name
36. Candidate's Signature*
37. Date*
    Date
39. Note: Submission of false, erroneous, or incomplete information may be subject to sanctions in accord with the Greenwood Village Municipal Code.
41. Filing Requirements
    Chapter 2, Article 1, Section 130

    For the purpose of meeting the filing requirements for candidates or committees under the Village’s Fair Campaign Reporting, electronic copies shall be accepted; provided that original documents are received by the City Clerk within five (5) days from the date of the electronic filing pursuant to Chapter 2, Article 1, section 130 of the Village’s Municipal Code. Reports/ Forms required are deemed timely if received by the City Clerk no later than 5:00 p.m., local time, on the designated day for filing.
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43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field