HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Best of the West - 10/2/2019Initial Application
Amended Application
Date:
COMMITTEE TYPE (choose one):
❑ Candidate
Committee Name (required):
(first or last name & office)
Candidate Information:
CITY OF GLENDALE
STATE OF ARIZONA
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COMMITTEE STATEMENT
OF ORGANIZATION
Candidate's Name (required): _ _
Candidate's mailing address (required):
Candidate's email address (required):
Candidate's phone number (required): _
Candidate's website (if any):
COMMITTEE ID NUMBER
(office use only)
_ W—Y
Office Sought (choose one): ❑ Governor ❑ Secretary of State ❑ Attorney General ❑ State Treasurer
❑ Superintendent of Public Instruction ❑ State Mine Inspector ❑ Corporation Commissioner .�
❑ State Senate
❑ County Office:
❑ City/Town Office:
❑ State House of Representatives ❑ District (required):. _
❑ District (if applicable):
❑District (if applicable):
Election Cycle for Office Sought (year the election will take place) (required):
Party Affiliation: N/A ❑ Democrat ❑ Green ❑ Libertarian ❑ Republican ❑ Other:
(required for partisan offices)
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11 Political Action Committee (PAC)
Committee Name (required):
(if sponsored, must include
sponsor's name)
Political Function (optional): []Contributions []Candidate -Related Independent Expenditures
(select any that apply) lz7kballot Measure Expenditures r] 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): ! _ _
Separate 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)
11 Political Party
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
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): SSC Cts Y_�-Jh wj
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 /3" /" C' t <a Date:
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Treasurer's signature:
Candidate's signature (if applicable):
Date:
Date:
Arizona Secretary of State Revision 11/5/16
Committee's email address (required):
Committee's phone number (if any):
Committee's website (if any):
2S.
Chairperson's Information:
Chairperson's name (required): , 04P_
Chairperson's physical address (required): ���35 weSF—
Chairperson's mailing address (if different):
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Chairperson's email address (required):.0 :/Y1-('g1-AaA
Chairperson's phone number (required):6 Gd ^ :3.1_ —
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Chairperson's employer (required):
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Chairperson's occupation (required):
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Treasurer's Information:
Treasurer's name (required):
Treasurer's physical address (required):
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Treasurer's mailing address (if different):
Treasurer's email address (required):
Treasurer's phone number (required):-6:�,t]R^ 5- 26
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Treasurer's employer (required):
Treasurer's occupation (required): ✓�
Bank or Financial Institution:
Bank name (required):
(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 /3" /" C' t <a Date:
�' a ^
Treasurer's signature:
Candidate's signature (if applicable):
Date:
Date:
Arizona Secretary of State Revision 11/5/16