HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Clark 2020 - 1/15/2019D Initial Application
Q Amended Application
Date:
CITYOFGLENDALE
STATE OFfy^qNA 1 £5 CITY
COMMITTEE STATEMENT
OF ORGANIZATION
COMMITTEE ID NUMBER
(office use only)
^'01
COMMITTEE TYPE (choose one):
/1 Candidate
Comm/ffee A/ame (required): Clark 2020
(first or last name & office)
Candidate Information: Candidate's Name (required): -'uyi^c v .
Candidate's mailing address (required): 8628 W. Cavalier Drive, Glendale, AZ S
Candidate's email address (required): ClarkJV@aol.COm
Candidate's phone number (required): 602-320-3422 (cell)
Candidate's website (if any): none as Of thlS date
Office Sought (choose one): n Governor D Secretary of State D Attorney General
D Superintendent of Public Instruction n State Mine Inspector
D State Treasurer
d Corporation Commissioner
a State Senate D State House of Representatives D District (required):
D County Office: _ D District (if applicable):
[3 City/Town Office: Councilmember [ZJDistrict (if applicable): Yucca district
Election Cycle for Office Sought (year the election will take place) (required): 2020
Party Affiliation: N/A D Democrat D Green D Libertarian D Republican D Other:
(required for partisan offices)
Q Political Action Committee (PAC)
Committee Name (required): Clark 2020
(if sponsored, must include
sponsor's name)
Po//Y/ca/Fuf7rt/of? (optional): Qcontributions [~~|candidate-Related Independent Expenditures
(select any that apply) Q Ballot Measure Expenditures [] Recall Expenditures
Sponsorship Information:
(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):
Special Status
(if applicable)
Qseparate Segregated Fund of a Corporation, LLC, Partnership, or Union
[Standing Committee (must also complete separate standing committee registration)
Mega PAC (must provide proof of Mega PAC status to filing officer) (amended applications only)
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I
I Political Party
Committee Name (required):
(must include party affiliation)
Jurisdiction:
dark 2020
Special Status
(if applicable)
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)
Q 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)
n Standing Committee (must also complete separate standing committee registration)
Arizona Secretary of State Revision 11/5/16
n Initial Application
II Amended Application
Date:
STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
COMMITTEE ID NUMBER
(office use only)
^-01
COMMITTEE INFORMATION:
Contact Information:Committee's mailing address (required): 8628 W. Cavalier Drive, Glendale, AZ &
Committee's email address (required): ClarkJV@aol.COm
Committee's phone number (if any): ou^-o^u-.
Committee's website (if any):
Chairperson's Information: Chairperson's name (required): JOYCG dark
Chairperson's physical address (required): 8628 W. Cavalier Dr., Glendale AZ 8&
Chairperson's mailing address (if different):
Chairperson's email address (required): Clarkiv@aol,COm
Chairperson's phone number (required): 602-320-3422 (cell)
Chairperson's employer (required):
Treasurer's Information:
Chairperson's occupation (required): Councilmember
Treasurer's name (required):
Treasurer's physical address (required): 8628 W. Cavalier Dr., Glendale AZ 85^
Treasurer's mailing address (if different):
Treasurer's email address (required): braVOl 22@JClOUd.COm
Treasurer's phone number (required): uu^.-o^.u-i
SelfTreasurer's employer (required):
Treasurer's occupation (required): Private Investigations
Bank or Financial Institution: Bank name (required): BMO Harris Bank
(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 herein. ; ^.,
Chairperson's signature:
Treasurer's signature:
Candidate's signature (if applicable):
Date:
Date:.
i(/tf ^l9
//////9
Date:
Arizona Secretary of State Revision 11/5/16