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HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Glendale Chamber PAC - 4/21/2017® Initial Application f-jAmended Application Date: COMMITTEE TYPE (choose one): Candidate Committee Name (required): (first or last name & office) Candidate Information: CITY OF GLENDALE STATE OF ARIZONA ` Y COMMITTEE STATEMENT OF ORGANIZATION Y 1 f Candidate's Name (required): Candidate's mailing address (required): Candidate's email address (required): Candidate's phone number (required): Candidate's website (if any): Office Sought (choose one): ❑ Governor ❑ Secretary of State ❑ Attorney General ❑ Superintendent of Public Instruction ❑ State Mine Inspector ❑ State Senate ❑ State House of Representatives ❑ County Office: ❑ City/Town Office: Election Cycle for Office Sought (year the election will take place) (required): Party Affiliation: N/A ❑ Democrat ❑ Green ❑ Libertarian (required for partisan offices) COMMITTEE ID NUMBER (office use only 1 -.tom 01 -A- ]X) 'TJ ❑ State Treasurer- ❑ Corporation CommissioneIr-- ❑ District (required): ❑ District (if applicable): []District (if applicable): ❑ Republican ❑ Other: f Xpolitical Action Committee (PAC) Committee Name (required): ! (✓1Ul ( �}�( 1 (if sponsored, must include sponsor's name) Political Function (optional): contributionsCandidate-Relate Independent Expenditures (select any that apply) 24allot Measure Expenditures Recall Expenditures Sponsorship Information: Sponsors name or nickname (required): (if applicable) Sponsor's mailing address (required): Sponsor's email address (required): Sponsors phone number (if any): Sponsors website (if any): Special Status ElSeparate Segregated Fund of a Corporation. LLC, Partnership, or Union (if applicable) Standing Committee (must also complete separate standing committee registration) Mega PAC (must provide proof of Mega PAC status to filing officer) (amended applications only) ElPolitical Party Committee Name (required): (must include party affiliation) Jurisdiction: ❑ State Party (must include proof of qualification pursuant to A.R.S. § 16-801 or § 16-804) County Party (must include proof of qualification pursuant to A.R.S. § 16-802 or § 16-804) ❑ 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) Special Status Standing Committee (must also complete separate standing committee registration) (if applicable) Arizona Secretary of State Revision 1115116 ❑ Initial Application STATE OF ARIZONA ❑ Amended Application COMMITTEE STATEMENT Date: sr, OF ORGANIZATION COMMITTEE INFORMATION: COMMITTEE ID NUMBER (office use only) � � csi7s� Contact Information: Committee's mailing address (required): _ / r �r� J ,Y00 l Y L C�Vr1 OIL, ,;c Committee's email address (required): Committee's phone number (if any): -4 3- 3?" -L"? -5 Y Committee's website (if any): ,q I.Fn cly 4 /C ecirn Chairperson's Information: Chairperson's name (required): Ste'_ Chairperson's physical address (required): 1 i�cyl iCepid , Chairperson's mailing address (if different): r,-; r re 2 25 3 9V Chairperson's email address (required): Cil ctv C e r d C,1 i^ r C t r*N Chairperson's phone number (required): 6d6 ' J133 ' 9.N,3 Chairperson's employer (required): •:Z cf{g :7-P'1SvC'Ct'-1 F Chairperson's occupation (required): .J•• ns L),t4%rC-C_ Treasurer's Information: Treasurer's name (required): `I ki C I<L n -G,C-�_ Treasurer's physical address (required): �/ ? �f� ' �kldc. Treasurer's mailing address (if different): (� ���1� fC Z YS 3 cf Treasurers email address (required): sty 4'."'1 ,-- d SY-4ror,-, Treasurer's phone number (required): -- n ? i is ,;� -I Treasurer's employer (required): Treasurer's occupation (required))): �n�cJniA✓1Cy. Bank or Financia! Institution: Bank name (required): R(h © , l cyzi T Y (do not list acct numbers) Additional bank name (ifapplicable): Additional bank name (if applicable): DECLARATION AND SIGNATURES: I declare under penalty of perjury that the foregoing information is true 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, including campaign finance laws codified at A.R.S. §§ 16-901 to 16-938; and (5) agree to accept all notifications and legal service of process for campaign finance purposes via the email address(es) provided herei . Vn/o Chairperson's signature: h ' Date: Treasurer's signature:`,� Date: Candidate's signature (if applicable): Date: Arizona Secretary of State Revision 11/5/16 (di