2016 MEMBERSHIP APPLICATION
TAX COLLECTORS & TREASURERS ASSOCIATION
OF SUSSEX AND WARREN COUNTIES
President-Linda Roth, CTC 1st Vice President-Lisa Gerickont, CTC 2nd Vice President-Dianne O’Connor, CTC
Secretary - Christine Rolef, CFO Treasurer - Theresa Schlosser, CTC Chaplin - Jessica Carusso, CMFO
I do solemnly declare and certify under the penalties of the law You do not need to send us your voucher for a separate
that the bill is correct in all particulars, the articles have been signature since the pre-signed certification on the left
furnished or services rendered as stated herein, that no bonus has can be attached to your voucher in lieu of sending it to
been given or received by any person or persons within the knowledge us for a signature. This form of certification of
of this claimant in connection with the above claim and that the amount performance of services has been determined by the
charged is a reasonable one. Local Finance Board to meet the requirements of the
Theresa Schlosser statutes for this type of expenditure.
Theresa Schlosser, Treasurer Please make check payable to: TCTASW
Mail together with self-addressed stamped envelope to:
YEAR 2016 DUES TCTASW c/o Theresa Schlosser, CTC
REGULAR MEMBERSHIP- $30.00 Franklin Borough
AFFILIATE MEMBERSHIP - $30.00 46 Main St.
BUSINESS MEMBERS- $75.00 Franklin, NJ 07416 FULLY RETIRED HOLDING NO POSITIONS- FREE
Due by June 1, 2016 to receive membership discounts on dinners.
PLEASE PRINT CLEARLY 2016 TCTASW MEMBERSHIP
PLEASE RETURN A COPY WITH YOUR CHECK SO THAT WE CAN KEEP OUR RECORDS ACCURATE