HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Weiers 2020 - 5/26/2017❑✓ Initial Application
F-1 Amended Application
Date:
COMMITTEE TYPE (choose one):
✓0 Candidate
Committee Name (required): WEIERS 2020
(first or last name & office)
CITY OF GLENDALE
STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
._...............-..._._._...._._............._._._._._._._._-._..........._._._.
COMMITTEE ID NUMBER
(office use only)
►7 -Oa
Candidate Information: Candidate's Name (required): JERRY WEIERS
Candidate's mailing address (required): 5025 N. 81 ST DR. GLENDALE, AZ 85
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 ❑ State Treasurer
❑ Superintendent of Public Instruction ❑ State Mine Inspector ❑ Corporation Commissioner
❑ State Senate ❑ State House of Representatives ❑ District (required):
❑ County Office:
❑ District (if applicable):
0 City/Town Office: MAYOR ❑District (if applicable): ry C3
Election Cycle for Office Sought (year the election will take place) (required): 2020
Party Affiliation: NIA ❑ Democrat ❑ Green ❑ Libertarian ❑ Republican ❑ Other:
(required for partisan offices)
❑ Political Action Committee (PAC)
Committee Name (required): WEIERS 2020
(if sponsored, must include
sponsors name)
Political Function (optional): []Contributions ❑Candidate -Related Independent Expenditures
(select any that apply) El Ballot Measure Expenditures ❑ Recall Expenditures
Sponsorship Information: Sponsors name or nickname (required):
(if applicable) Sponsors mailing address (required):
Sponsors email address (required):
Sponsor's phone number (if any):
Sponsor's website (if any):
Special Status Separate 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)
F] Political Party
WEIERS 2020
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 11/5/16
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Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER
Amended Application COMMITTEE STATEMENT (office use only
Date: OF ORGANIZATION
COMMITTEE INFORMATION:
Contact Information: Committee's mailing address (required):
Committee's email address (required):
Committee's phone number (if any): _
5025 N. 81 St Dr. Glendale, AZ 85303
Committee's website (if any):
Chairperson's Information: Chairperson's name (required): JERRY WEIERS
Treasurer's Information:
Chairperson's physical address (required): 5025 N. 81St Dr. Glendale, AZ 85303
Chairperson's mailing address (if different):
Chairperson's email address (required): _
Chairperson's phone number (required): _
Chairperson's employer (required):
Chairperson's occupation (required):
Treasurer's name (required): MICHAEL W. LAW
Treasurer's physical address (required): 6955 E. Baseline 107 Mesa, AZ 85209
Treasurer's mailing address (if different):
Treasurer's email address (required): mike@laWreed.COm
Treasurer's phone number (required): 480-827-0370
Treasurer's employer (required): LAW & REED
Treasurer's occupation (required): CPA
Bank or Financial Institution: Bank name (required): 40 /7
(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 a committee named herein, if applicable; (2) designate the above-named committee as my official candidate
committee and authorize it o eceive/make contributionstexpenditures on my behalf, if applicable; (3) have read the Secretary of State's
campaign financed rep rti guide; (4) agree to comply with Arizona election law, including campaign finance laws codified at A.R.S.
§§ 16-901 to 16-938, nd ) re to acc t all notifications and legal ice of process for campaign finance purposes via the email
address(es) provided rei .
Chairperson's signature: Date: SA7
Treasurer's signature:
Candidate's signature (if
Date:
Date:
Arizona Secretary of State Revision 11/5/16