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HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Clark for Council - 3/9/2016CITY / TOWN OF POLITICAL COMMITTEE STATEMENT OF ORGANIZATION CITY CLERK Titles 16 & 19 Arizona Revised Statutes CITY OF G L E N D 4 L E Definitions, statutory references and important information on reverse. 20116 MAR -9 PM 1= 59 Initial Registration FlOut of State Committee ❑Amended Statement ID# ICO-oI NAME OF POLITICAL COMMITTEE C-1-Ace— r DTE©Lwolte ADDRESS (NUMBER & STREET) CITY STA ZIFY MAILING ADDRESS (If different from above) CITY STATE ZIP COMMITTEE TELEPHONE # COMMITTEE FAX # COMMITTEE E-MAIL ADDRESS 107 DOES THE POLITICAL COMMITTEE HAVE A SPONSORING ORGANIZATION?❑ YES NO 21 If yes, please provide the following information: NAME OF SPONSORING ORGANIZATION TYPE OF ORGANIZATION ADDRESS OF SPONSORING ORGANIZATION RELATIONSHIP TO POLITICAL COMMITTEE TYPE OF POLITICAL COMMITTEE - Please check only one box: CANDIDATE'S CAMPAIGN COMMITTEE1:1AN ASSOCIATION OR COMBINATION OF PERSONS THAT MEETS BOTH CRITERIA: ❑ SEPARATE SEGREGATED FUND (A.R.S. § 16-920 (A)) 1. IS ORGANIZED, CONDUCTED OR COMBINED FOR THE AN ASSOCIATION OR COMBINATION OF PERSONS THAT CIRCULATES PRIMARY PURPOSE OF INFLUENCING THE RESULTS OF ANY ELECTION; AND PETITIONS IN SUPPORT OF THE QUALIFICATION OF A BALLOT MEASURE 2. KNOWINGLY RECEIVES CONTRIBUTIONS OR MAKES Petition Serial Number ------------ EXPENDITURES OF MORE THAN $500 IN CONNECTION WITH ANY ELECTION DURING A CALENDAR YEAR. F-1ANASSOCIATION OR COMBINATION OF PERSONS THAT CIRCULATE A ❑ POLITICAL ORGANIZATION (see A.R.S. § 16-823) RECALL PETITION ❑ POLITICAL PARTY (see A.R.S. §§ 16-801, 16-804,16-821 and 16-825) ❑ EXPLORATORY COMMITTEE ❑ OTHER TYPE OF COMMITTEE (please describe) F—ICHECK HERE IF REGISTERED WITH THE SECRETARY OF STATE AS A STANDING POLITICAL COMMITTEE PURSUANT TO A.R.S. § 16-902.01. L (You must provide a copy of the statement of organization filed with the Secretary of State designating standing committee status) EACH POLITICAL COMMITTEE SHALL HAVE A CHAIRMAN AND TREASURER. THE POSITION OF CHAIRMAN AND TREASURER OF A SINGLE POLITICAL COMMITTEE MAY NOT BE HELD BY THE SAME INDIVIDUAL, EXCEPT THAT A CANDIDATE MAY BE CHAIRMAN AND TREASURER OF HIS OR HER OWN CAMPAIGN COMMITTEE. A.R.S. §16-902(A). NAME OF COMMITTEE CHAIRMAN CLi��C,�L CHAIRMAN'S TELEPHONE # CHAIRMAN'S FAX # 'l% ce X23 -7?Z ' �T 3 CHAIRMAN'S ADDRESS CITY STATE ZIP r` -3 CHAIRMAN'S OCCUPATION CHAIRMAN'S EMPLOYER CHAIRMAN'S E-MAIL ADDRESS eo . NAME OF COMMITTEE TREASURER TREASURER'S TELEPHONE # TREASURER'S FAX # V1.4) 01".40— %Z - 3 Z& - &/ Z TRE ,qk;R S ADDRIESS p CIT � STATE /I / ZIP TREASURER'S OCCUPATION TREASURER'S EMPLOYER TREASURER'S E-MAIL ADDRESS A POLITICAL COMMITTEE THAT ACCEPTS A CONTRIBUTION OR MAKES AN EXPENDITURE SHALL DESIGNATE AT LEAST ONE ACCOUNT AT A QUALIFIED FINANCIAL INSTITUTION (A.R.S. § 16-902(C)). LIST THE NAMES OF ALL FINANCIAL INSTITUTIONS WITH WHICH THE COMMITTEE MAINTAINSACCOUNTS OR SAFETY DEPOSIT BOXES. (Do not list account numbers.) � A11< OF I°'/ 6 CA 1 2. 3. FOR AN EXPLORATORY COMMITTEE OR A CANDIDATE'S CAMPAIGN COMMITTEE, PROVIDE THE FOLLOWING INFORMATION: (Office sought is optional for an Exploratory Committee.) NAME OF DESIGNATING INDIVIDUAL (DI) OR CANDIDATE � CANDIDATE'S ORDQE-SIGNNAATING II,NDDIIVIDUAL' E-MAIL ADDRESS l OFFICE SOUGHT �r DI's OR CANDIDATE'S ADID'R,ESS,,yy CITY ,) STAT ZIP / CANDIDATE'S (or DESIGNATING INDIVIDUAL'S) STATEMENT: I authorize the above-named political committee as my political committee to receive contributions and make expenditures on my behalf for the election in 2016. , Date: /09F Candidate's or D/1's signature: CHAIRMAN'S AND TREASURER'S STATEMENT: We, the undersigned, purs a o A.R.S. § 16-902.01(86) have read all the applicable laws relating to campaign finance and reporting and have examined the information contained in this statement of organizatiio�n agdd,, to the best of our knowledge and belief, it is true, correctAnd co plete. & Date: D ! ©LT A� Chairman's signature: r Date: o Treasurer's signature: DEFINITION OF POLITICAL COMMITTEE: A.R.S. § 16-901(19) "Political committee" means any of the following: a) A candidate or a candidate's campaign committee. b) A separate, segregated fund established pursuant to section 16-920, subsection A, paragraph 3. c) An association or combination of persons that circulates petitions in support of the qualification of a ballot measure, question or proposition. d) An association or combination of persons that circulates a petition to recall a public officer. e) A political party. f) An association or combination of persons that meets both of the following requirements: i. Is organized, conducted or combined for the primary purpose of influencing the result of any election in this state or in any county, city, town or other political subdivision in this state, including a judicial retention election. ii. Knowingly receives contributions or makes expenditures of more than five hundred dollars in connection with any election during a calendar year, including a judicial retention election. g) A political organization. h) An exploratory committee. The types of political committees are listed on the front of this form. NOTE FOR INDIVIDUALS INVOLVED IN POLITICAL ACTIVITIES: An individual acting alone, unless that individual is a candidate, is not a political committee under Arizona law and need not file a statement of organization. If any additional person or persons join t he effort begun by an individual and meets th e definition of a "political committee" in A.R.S. § 16-901(19) under Arizona law, the committee must register pursuant to A.R.S. § 16-902.01(A). NOTE FOR THOSE INVOLVED IN INITIATIVE, REFERENDUM AND RECALL EFFORTS: Before circulating initiative, referendum or recall petitions, a political committee must file its statement of organization with the appropriate filing office. Signatures obtained on petitions prior to the filing of the statement of organization are void and shall not be counted in determining the legal sufficiency of the petition. A.R.S. §§ 19-114(B) and 19-202(C). Even though an individual, acting alone, may begin t he initiative, referendum or recall effort, as s oon as other pers ons join t he effort to circulate petitions in support of the effort, the association of persons must register as a political committee.