supplement_declaration_temp

Department Name

Name:

Business Phone

Mobile Phone

Address

City

State

Zip

Will you be uploading a Supplemental Declaration Form Excel Spreadsheet or completing the online form?

Online Form

Spreadsheet

Sample Spreadsheet:
levine-test.xlsx

Upload Spreadsheet:

Name of Project or Agreement

Please upload your Board Letter and/or Supporting Documents (PDF and Word files only):

Name of Applicant(s) or Part(ies)

Title of Proceeding

(Title of Board Letter)

Type of Proceeding:

Contract

License

Permit

Franchise

Other Entitlement for Use

Agenda Number

Agenda Date

Filling Date

Reported Campaign Contribution

Notes

Signature

Clear Save Signature

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