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) The Applicant and the Owner/Lessor hereby discloses as follows. (If printing, please print legibly. Use additional sheets as necessary.) I. Name of Applicant and Name of Owner/Lessor on whose behalf application is filed:
Full Name Title Business Address City State Zip
II. Officers or owners/investors of Applicant Entity.
Full Name Title Business Address City State Zip
III. Contractor of Applicant(s) Seeking Entitlement*
Full Name Title Business Address City State Zip
IV. Subcontractor of Applicant(s) Seeking Entitlement** Full Name Title Business Address City State Zip
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