City of Glendale
Disclosure - Campaign Finance Ordinance
Applicants Seeking Entitlement
Submit to Permit Services Center, 633 E. Broadway, Rm. 101.
For more information. call 818-548-3200.
(To be Completed Prior to Preparation of Staff Reports for Consideration of Entitlement Matter by Council, Agency, or Authority, or at Time of Appeal to the City Council if the Applicant is also the Appellant) In August 2011, the Glendale City Council adopted Ordinance No. 5744, which becomes effective on September 9, 2011 ("Ordinance"). The Ordinance prohibits campaign contributions from "applicants seeking entitlement," their contractors and subcontractors (including their architects, engineers, and design professionals) while the application is "pending" and for 12 months thereafter. The Ordinance also prohibits Council Members from voting on any matter pertaining to an entitlement if the Council member has received a campaign contribution from the applicant seeking the entitlement, or certain contractors or subcontractors of the applicant, within the 12-month period preceding the vote.
The Applicant and the Owner/Lessor hereby discloses as follows. (If printing, please print legibly. Use additional sheets as necessary.)
1. Name of Applicant and Name of Owner/Lessor on whose behalf application is filed:
Full Name Title Business Address City State Zip
TImoTHy H. Scullydr 1504 BEL AME DR SLENDALE CA
MARIAN. Cassen Sellly CA 91201
504 BEL AIRE DR *LEMDALE
City of Glendale, Community Development Department (9/9/11)
1. Officers or owners/investors of Applicant Entity. Please also disclose the following persons or entities related to the applicant entity: CEO/President, Chairperson, Chief Operations Officer, Chief Financial Officer, any member of the Board of Directors, and any individual or entity that owns 10% or more the contractor of applicant seeking entitlement, as well as any campaign + Full Name Title - Business Address City | State
Ill. Contractor of Applicants) Seeking Entitlement*
Full Name Title Business Address City State
* "Contractor of Applicant Seeking Entitlement" means "a person who has, or has been promised, a contract as an architect, design professional, engineer, or general or prime contract with an applicant seeking entitlement. "Contractor of applicant seeking entitlement," includes not only the contracting party but also the CEO/President, Chairperson, Chief Operations Officer, Chief Financial Officer, any member of the Board of Directors, and any individual or entity that owns 10% or more the contractor of applicant seeking entitlement, as well as any campaign committee that is sponsored and controlled by the contracting party.
Please list the names and addresses of all of these parties.
IV. Subcontractor of Applicants) Seeking Entitlement**
Full Name Title Business Address city State Zip
** "Subcontractor of Applicant Seeking Entitlement" means "a person who has, or has been promised, a subcontract as an architect, design professional, engineer, or perform other work with a 'contractor an applicant seeking entitlement."
City of Glendale, Community Development Department (9/9/11) "Subcontractor of applicant seeking entitlement," includes not only the subcontracting party, but also the CEO/President, Chairperson, Chief Operations Officer, Chief Financial Officer, any member of the Board of Directors, and any individual or entity that owns 10% or more the subcontractor of applicant seeking entitlement, as well as any campaign committee that is sponsored and controlled by the subcontracting party. Please list the name and addresses of all of these parties.
V. Disclosure. The Applicant Seeking Entitlement has made campaign or officeholder contributions in the preceding 12 months to City of Glendale elected officials as follows:
Elected Official Name of Individual or Entity Date of Contribution I hereby certify, on behalf of the above-named applicants) and owners)/lessors), that the applicant seeking entitlement has made the campaign contributions as set forth above. also certify that the names of all contractors of applicant and all subcontractors of applicant, as of today's date, are fully set forth above. further acknowledge that the applicant has a continuing obligation to update this disclosure form if the applicant selects additional or substitute architects, design professionals, contractors or subcontractors within ten (10) days of the selection or change. I hereby certify that I have been legally authorized by the applicant/owner/lessor to submit this disclosure form and certify to the content hereof.
I declare under penalty of perjury that the foregoing is true and correct.
Executed on 10/22/24 at GLENDALE , California
Applicant's Signature. Implan → Print Applicant's Ful Name I'morty Ht. Seen k Applicant's Address 15T04) BEL ANDE DA. GLENDALE CA 91201 Applicant's Contact Phone Number 202 7446644
Applicant's Email Address JuiLRosES a MAC. Con
City of Glendale, Community Development Department (9/9/11)