TCTA of Sussex & Warren Counties

Click here to edit subtitle

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        

 

NAME_____________________________________________________          TITLE_______________________________________________

MUNICIPALITY _____________________________________________ 

ADDRESS__________________________________________________________________________________________________________

TELEPHONE______________________________________________          FAX_________________________________________________

EMAIL_____________________________________________________________________________________________________________

 

NAME_____________________________________________________          TITLE_______________________________________________

MUNICIPALITY _____________________________________________ 

ADDRESS__________________________________________________________________________________________________________

TELEPHONE______________________________________________          FAX_________________________________________________

EMAIL_____________________________________________________________________________________________________________