HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - A Better Glendale - 7/13/2018lication
QAmended Application
'Date: 1/(:2)/a-0|^
CITC OF GLENDALE
STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
8JULi3°'si4 CGCW1M1TFBBJJ3 NUMBER
-D'-i '(bfti^uwonly)
l^-<?5
COMMITTEE TYPE (choose one):
Q Candidate
Committee Name (required):
(first or last name & office)
Candidate Information:Candidate's Name (required):
Candidate's mailing address (required):
Candidate's email address (required):
Candkiate's phone number (required):
Candidate's website (if any):
Office Sought (choose one): D Governor D Secretary of State
D Superintendent of Public Instruction
D Attorney General
d State Mine Inspector
a State Treasurer
D Corporation Commissioner
a State Senate
D County Office:
Q City/Town Office:
D State House of Representatives D District (required):
a District (if applicable):
ClD istrict (if applicable):,
Election Cycle for Office Sought (year the election will take place) (required):
Party Affiliation: N/A a Democrat D Green D Libertarian
(required for partisan offices)
a Republican D Other:
Q Political Action Committee (PAC)
Commfftee Name (required): ^ f^Tf^/^ <Q/^A \!)-
(if sponsored, must include
sponsor's name)
Political Function (optional): Qcontributions QCandidate-Related Independent Expenditures
(select any that apply) | [Ballot 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):
Qseparate Segregated Fund of a Corporation, LLC, Partnership, or Union
jJStanding Committee (must also complete separate standing committee registration)
Mega PAC (must provide proof of Mega PAC status to filing officer) (amended applications only)
['"jpolitical Party
Committee Name (required):
(must include party affiliation)
Jurisdiction:
Special Status
(if applicable)
liflcation 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)
II Standing Committee (must also complete separate standing committee registration)
Arizona Secretary of State Revision 11/5/16
[^Initial Application
Amended Application
151ate: '7/13?/2-^1&
STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
COMMITTEE ID NUMBER
(office use only)
COMMITTEE INFORMATION:
Contact Information:
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Committee's mailing address (required):--?<^3^ AS^y.f^^U-Sc/^f//'^'-
Committee's email address (required): A^-Sf/'yL^^/^ lS^^> ^(A^^ <^^-(
Committee's phone number (if any):
Committee's website (if any): ,JL
Chairperson's Information: Chairperson's name (required): '/ //^ /4,.
7^?^A.^X^'C^<-^>.5 ^^ /^^f
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Treasurer's Information:
Chairperson's physical address (required):
Chairperson's mailing address (if different):
Chairperson's email address (required): ^/V/^//^3 . UJ£>^\/{ :/(j^^oficJi^^f3/^7^^>
Chairperson's phone number (required): G"t£7^''/-e^"'/i3
Chairperson's employer (required): ^^.^'^£^r) //%^7'^>?^^fl/-^<£^?^>'^
Chairperson's occupation (required): <^*<?^^A<&^>-'>
Treasurer's name (required): /1'/r{£- <_fr\/Y^">r^''
Treasurer's physical address (required): '^'^/£> ^Ml< ^&JL>f^uA£^.< <:^'Kt^4^>4^'^S>
Treasurer's mailing address (if different); .S.. ^- ^4'
Treasurer's email address (required): }1 >^ ^ <^p//f 7?& ^'/.^.^l/^ 6-)Ml.'A
Treasurer's phone number (required): b<"}^"~'^T'^/~ <2S
/^%^^2?
^.0^
Treasurer's employer (required):
Treasurer's occupation (required): /C/^//>irZ-^
Bank or Financial Institution: Bank name (required): /A//^/ Z ^ ^A^Jf-^ 0
(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, induding 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 herein.
Chairperson's signature:
Treasurer's signature:
Candidate's signature (if applicable):
Date
Date:
Date:
,: 7- /3-/S
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Arizona Secretary of State Revision 11/5/16