HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Allen for Glendale - 10/16/2017Sl Initial Applk^tion
QAmended Application
Date:
CITY OF GLENDALE
STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
COMMITTEE ID NUMBER
(office use only)
,7-^7
COMMITTEE TYPE (choose one):
[3 Candidate
Committee Name (required): Alien for Glendale
(first or last name & office)
Candidate Information: Candidate's Name (required): Emmanuel Alien
Candidate's mailing address (required): 5750 N. 59th Ave.#120 Glendale 85301
Candidate's email address (required): allen4glendale@gmail.COm
Candidate's phone number (required): 602-488-01 47
Candidate's website (if any): WWW.allen4glendale.COm
Office SougW (choose one): D Governor D Secretary of State a Attorney General a State Treasurer
0 Superintendent of Public Instruction D State Mine Inspector a Corporation Commissioner
D State Senate D State House of Representatives D District (required):
a County Office: _ D District (if applicable):
[3 city/Town office: Glendale
_
ElD istrict (if applrcabte): OcOtillO
Election Cycle for Office Sought (year the electron will take place) (required); 2018
a Green d Libertarian D Republican D Other:Party Affiliation: N/A a Democrat
(required for partisan offices)
cr'i
..(:a.,
Political Action Committee (PAC)
Committee Name (required): Alien for Glendale
(if sponsored, must include
sponsor's name)
Political Function (optional): Qcontributions Qcandidate-Related Independent Expenditures
(select any that apply) QB altot Measure Expenditures [] Recall Expenditures
Sponsorship Information:
(if applicable)
Special Status
(if applicable)
Sponsor's name or nickname (required):
Sponsor's mailing address (required):
Sponsor's email address (required):
Sponsor's phone number (if any):
Sponsor's website (if any):
tion, LLC, Partnership, or Union
(Standing Committee (must also complete separate standing committee registration)
[ Mega PAC (must provkle proof of Mega PAC status to filing offfcer) (amended applications only)
["[Political Party
Committee Name (required):
(must include party affiliation)
Jurisdiction:
Alien for Glendale
Special Status
(if applicable)
(must include proof of qualification pursuant to A.R.S. § 1 6-801 or § 16-804)
^.R.S. § 16-802 or § 16-804)
Q Legislative District Party (must include proof of organization pursuant to A.R.S. § 16-823)
[_] City or Town Party (must include proof of qualification pursuant to A.R.S. § 16-802 or § 16-804)
Arizona Secretary of State Revision 11/5/16
Initial Apptication
Q Amended Application
Date:
STATE OF ARIZONA
COMMm-EE STATEMENT
OF ORGANIZATION
COMMITTEE ID NUMBER
(office use only)
COMMITTEE INFORMATION:
Contact Information: Committee's mailing address (required): 575° N - 59th Ave -#120 Glendale 8530 1
Committee's email address (required): allen4glendale@gmail.COm
Committee's phone number (if any): 602-488-0147
Chairperson's Information:
committee's webste (if any): www.allen4glendale.com
Chairperson's name (required): BellPda Alien
Chairperson's physical address (required): 5750 N 59th Ave#120 Glendale 85301
Chairperson's mailing address (if different):
Chairperson's email address (required): belinda_allen03@hOtmail.COm
Chairperson's phone number (required): 602-434-6295
Chairperson's employer (required): SOUthWCSt Network
Chairperson's occupation (required): Case Manager
Treasurer's Information: Treasurer's name (required): Christy Mullally
Treasurer's physical address (required): 6768 W. AmJQO Dr. Glendale, AZ 85308
Treasurer's mailing address (if different):
Treasurer's email address (required): Christilla24@yahOO.COm
Treasurer's phone number (required): 267-642-6005
Treasurer's employer (required):
Treasurer's occupation (required):
Bank or Financial Institution: Bank name (required): Wells FaFQO Bank
(do not list acct numbers) Additional bank name (ifapplteable):
Additional bank name (if applicable):
DECLARATION AND SIGNATURES:
I declare under penalty of perjury that the foregoing information is tme and correct. I further declare that I: (1) consent to serve as
chairperson or treasurer of the committee named herein, if applicable; (2) designate the above-named committee as my official candidate
committee and authorize it to receive/make contributions/expenditures on my behalf, if applicable; (3) have read the Secretary of State's
campaign finance and reporting guide; (4) agree to comply with Arizona election law, induding campaign finance laws codified at A.R.S.
§§ 16-901 to 16-938; and (5) agree to accept alt noh'fications and legal service of process for campaign finance purposes via the email
address(es) provided herein.
Chairperson's signature:Date:10//(t 1^1 7
Treasurer's signature: '^-A'oVT^A-j ^\ ^ A
Candidate's signature (if applicable):^ (^%
Date: <^<A£^0^ \V, ^^Q ^-f
Date: 10-1^- ^ >i!~7
Arizona Secretary of State Revision 11/5/16