SEEC FORM 1 aE rears STATE ELECTIONS ENFORCEMENT COMDISSION shay) ‘ ine Registration by Candidate tae Rede Septonber2018 } EGSRATON TP [UALECHONDATE apes ——_[EMUNTCIPRET ©rsst_ Oamotont | yosnor9 Danbury oFRCTOR ORTON SOUGHT ERROR me Board of Editon EAT AMAETIO ORepidion © Democratic Other est oeoph Dasiva o FCaNDIDATERENDINCE ADDR CANDIDATE MAILING ADDS waa ‘8 Wanington Avo Dantury ct foset0 [caNDmTTELERONE TGNODATEENATC ADDRES pos ana4308 JDasivelr@gnatcom ‘DISTORTION OF CANPATON FINDING SOURCE [(Check one) B A. Lam forming a candidate committee and I am required to file a Candidate Committee Registetion Statement. Goto Rorm 1A ant complete pages 2 and 3— Candidate Registration Statement 1B. Lam exempt rom fyming anda commits and an ing a Cerifation of Exemption from Forming a Candidate Committee Gio to Form AB cond complete page 4 — Cerifcaton of Exemption from Forming a Candidate Commitee. Tmportant Note: Faire ofa exndidate to complete this page fogether with elther Form 1A, “Registration ‘ot Candidate Committe,” or Form 1B "Exemption from Forming a Candidate Committee,” within 10 dn ‘of becoming a candidate will subject the etndidate(o# mandatory $100 int filing fe. ‘See Section 9-623(0), Connecticut General Statutes Mang fale sate on this form may sit outer penaliy, nang bu Tinted a, mpicmnt far pane a ine po tows dlrs bahSEEC FORM 1A STATE ELECTIONS ENFORCEMENT COMMISSION ‘andidate Committee Registration Statement Reviseé Septmber 2016 TGRTRATIONT _ @hitst —Cncndmen | Joseph Dasiva, Je Dasve@ 20/7 i coNRETEE ABORT a NTT ATE TE wating ve ‘Deseo com Danby Jor sera ica = =| Unga 8 [ese SRR ESTER ATORES RT 157 Kraan Se sae Dostuy cr fooets TREO RNA ATOR forests Lneb0eSiegl on ae ea aa DEPT TASTIIR RESIDINCH ADDRESS DU TREASURER MAILING ADDIS AD i DET TREASURER TELEPHONE DEPOT FASTA ADDRES a DEPOSTORY NTTTUTION WANE ‘Union Savings Bark [7 DEPOSTORY INSTITUTION ADDRESS 226 Main Sreet crea‘SPEC FORM 14, resort Fevsed Soptnoor 2016 nist Qanensnen | Joseph Dasiva, J hereby certify and state, under penalties of false statement, that al ofthe designations sot forth in this candidate committee regsation statement are tre and accurate o thebestof my knowledge and belie, and further, that Tat that any individual designated herein to serve as my treasurer to thse positions. Met hereby certify and state, under penalties of file statement, that Ihave accepted my appointment by the ‘eandidate to serve asthe candidate's designated treasurer ofthis eandiate committe. I cerifythat lam an ‘lectorin the State of Comectint | inten to comply with all the campaign finance registration and disclosure requirements as contained in Chapter 155 throug 157 ofthe General Statute, and to abide by any prohibitions, iatons or restrictions concerning campaign contributions and expenditures. 1 certify that have paid any civil penalties o forfeitures assessed pursuant to Chapters 155 t0 157, elusive. {certify that have not been convicted of or pled guilty or nolo contendere to, in a court of competent jirsdicton, any (A) felony involving fraud, forgery, larceny, embezzlement or bribery, or (B) criminal offense tinder Title 9 of the General Statues, or tha t leas eight years have lapsed from the date ofthe conviction or pls othe competion of any sentence, whichever date i Ine, without a subsequent conviction of or plea to nother such felony or offense. 1 certify that Lm not otherwise bared from serving asa treasurer by order ofthe State Fectons Enforcement Thereby cetfy and state under penalties of false statement, that have accepted my appointment by the candidat to serve a the candiate’s designated deputy treasurer of this candidate commie, and I understand land accept that, inthe event ofa vacancy eased by the easurer's death incapacity or resignation, I shall “uomatially become responsible fr discharging al ofthe duties required ofthe vacating Weasurer. I certify that fam an elector in the State of Connecticut. 1 intend to comply with all he campaign finance registration and disclosure requirement as contained in Chapter 155 though 157 ofthe General Statutes, and to abide by ny Prohibitions, limitations or estritions concerning campaign contributions and expenditures. 1 certify that have pid any civil penalies or forfeitures assosed pursuant to Chapters 15S to 157, inclusive. {certify that have not been convicted of or ped guilty or nolo contendere to, in a court of competent jiwisdicton, any (A) felony involving frau, forgery, laveny, embezzlement or bribery or (B) criminal offense ‘under Title 9 of the General Status, or that at least eight years have elapsed from the date of the conviction or plea ortho completion of my sentence, whichever date is ate, without a subsequent conviction of or pls to nother such felony or offense. 1 certify that Lm not otherwise bated from serving asa deputy treasrer by order ofthe State Elections Enforcement Comission,