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2. Instructions

   Please fill out all relevant fields.

   Items marked with an asterisk (*) are required.

4. Committee Name
6. 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
8. Name of Person Acting as Registered Agent (Treasurer)
10. Is this a Replacement Registered Agent?

    1. Yes

    1. No
12. Physical Address
14. City
15. State
16. Zip
18. Mailing Address
20. City
21. State
22. Zip
24. Phone Number
25. Email
27. Financial Institution Name
29. Is this a Replacement Financial Institution?

    1. Yes

    1. No
31. Institution Physical Address
33. Registered Agent's Signature*
34. Date*
    Date
36. Candidate Name
38. Candidate's Signature*
39. Date*
    Date
41. Note: Submission of false, erroneous, or incomplete information may be subject to sanctions in accord with the Greenwood Village Municipal Code.
43. 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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45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit Submit and Print

* indicates a required field