HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - The Glendale Community Voice Box - 4/5/2018Q Initial Application
r-jAmended Application
Date: 901 04-0
COMMITTEE TYPE (choose one):
0 Candidate
Committee Name (required):
(first or last name & office)
Candidate Information:
Office Sought (choose one):
CITY OF GLEN®ALE
STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
r X
The Glendale Community Voice Box
Candidate's Name (required):
Candidate's mailing.address (requ€rad):
Candidate's email address (required)' _
Candidate's phone number (required): _
Candidate's websile tlf any):
❑ Governor 0 Secretary of State
❑ Superintendent of Public Instruction
COMMITTEE ID NUMBER
I
(office use only)
......---..................... ..... .................................................
J
0 Attorney General 0 State Treasurer
El State Mine Inspector 0 Corporation Commissioner
F1 State Senate ❑ State House of Representatives Ci District (required):
0 County Office:
® City/Town Office:
Election Cycle for Office Sought (year the election will take place) (required):
Party Affiliation: N/A C7 Democrat ❑ Green 13 Libertarian
(required for partisan offices)
0 District (if applicable):
[]District (if applicable): _.
0 Republican 0 Other:
0 Political Action Committee (PAC)
Committee Name (required): The Glendale Community Voice Box
(if sponsored, must include
sponsor's name)
Political Function (optional): ®Contributions Candidate -Related Independent Expenditures
(select any that apply) ® Ballot Measure Expenditures 11 Recall Expenditures
Sponsorship Information: Sponsor's name or nickname (required):
(if applicable) Sponsor's mailing address (required): _
Sponsor's email address (required): _
Sponsor's phone number (if any):
Sponsor's website (if any): „� _
Special Status R Separate Segregated Fund of a Corporation, LLC, Partnership, or Union
(if applicable) Standing Committee (must also complete separate standing committee registration)
0 Mega PAC (must provide proof of Mega PAC status to filing officer) (amended applications only)
®Political Party
The Glendale Community Voice Box
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)
r] 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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tJ Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER
�1 car (office use only)
E] Amended A fication COMMITTEE STATEMENT
Date: 04-OftP2018 OF ORGANIZATION i
COMMITTEE INFORMATION:
Contact Information: Committee's mailing address (required): 7302 N 58th Drive Glendale Az 85301
Committee's email address (required): Bud@GlendaleCVB.com
Committee's phone number (if any):
Committee's website (if any): http'Hglendalecommunityvoicebox.com
Chairperson's Information: Chairperson's name (required): Bud Zomok
Chairperson's physical address (required): 7302 N 58th Drive Glendale Az 85301
Chairperson's mailing address (if different): Same
Chairperson's email address (required): ZomCO@Outlook.Com
Chairperson's phone number (required): 602-909-6622
Chairpersons employer (required): Banner Estrella Medical Center
Chairperson's occupation (required): Director
Treasurer's Information: Treasurer's name (required): Lorraine Zomok
Treasurer's physical address (required): 7302 N 58th Drive Glendale Az 85301
Treasurer's mailing address (if different): Same
Treasurer's email address (required): LorraineZomok@Gmaii.com
Treasurer's phone number (requiredy 602-619-8894
Treasurers employer (required): None
Treasurer's occupation (required): Retired
Bank or Financia/lnstitution: Bank name (required): BMO Harris
(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 her ` .�
Chairperson's signature, Date:' -A~
/J % f f
Treasurer's signature: "`�""'l-� �°`~�Date: I � I
Candidate's signature (if applicable):
Date:
Arizona Secretary of State Revision 11/5/16