HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Best of the West - 10/23/2019{,]Initial Application
Amended Application
Date: T
�Q a3';L
COMMITTEE TYPE (choose one):
❑ Candidate
Committee Neme (required):
(first or last name & office)
CITY OF GLENDALE
STATE OF ARIZONA COMMITTEE ID NUMBER
COMMITTEE STATEMENT (office use only)
OF ORGANIZATION 19-Q4
Candidate information: Candidate's Name (required):
Candidate's mailing address (required):
Candidate's email address (required): _
Candidate's phone number (required): _
Candidate's website (if any):.
Office Sought (choose one): ❑ Govemor ❑ Secretary of State
❑ Superintendent of Public Instruction
❑ Attorney General ❑ State Treasurer
❑ State Mine Inspector ❑ Corporation Commissioner
❑ Stale Senate ❑ Stale House of Representatives ❑ District (required):
❑ County Office:
_ [I District (if applicable):
[] City/Town Office:
Eiection Cycle for Office Sought (year the election will take place) (required):
PartyAlfiliation: N/A ❑ Democrat ❑ Green ❑ Libertarian
(required for partisan offices)
❑District (if applicable):
❑ Republican ❑ Other:
Political Action Committee (PAC)
Committee Name (required):
Best of the West
(if sponsored, must include
sponsor's name)
Political Function (optional):
❑Contributions ❑Candidate -Related Independent Expenditures
(select any that apply)
0Ballot Measure Expenditures [] 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
Separate Segregated Fund of a Corporation, LLC, Partnership, or Union
(if applicable)
HStanding Committee (must also complete separate standing committee registration)
0 Mega PAC (must provide proof of Mega PAC status to filing officer) (amended applications only)
nPolitical Party T - —
Commiftee Name (required): -
(must include party affiliation)
Jurisdiction: []State Parry (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. § 116-823)
❑ 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 11/5116
Initial Application
Amended Application
Date: IRON q
COMMITTEE INFORMATION:
Contact Information:
Chairperson's Information:
Treasurer's Information:
STATE OF ARIZONA COMMITTEE ID NUMBER
COMMITTEE STATEMENT (office use only)
OF ORGANIZATION 19-04
Committee's mailing address (required): 5835 West Belmont Ave. Glendale, AZ
Committee's email address (required): Diane.McCarthy@west-mec.org
Committee's phone number (if any):
Committee's website (if any):
Chairperson's name (required): Diane B. McCarthy
Chairperson's physical address (required): 5835 West Belmont Aye.Glendale, AZ
Chairperson's mailing address (if different):
Chairperson's email address (required) Diane.MCCarthy@west-mec.Orq
Chairperson's phone number (required): 602-315-3517
Chairperson's employer (required). Retired
Chairperson's occupation (required):
Treasurer's name (required): Vern Crow
Treasurers physical address (required): 20045 North 19th Avenue, Phoenix, AZ
Treasurer's mailing address (if different):
Treasurer's email address (required): vcrow4l99@gmail.com
Treasurer's phone number (required): 623-516-1415
Treasurer's employer (required): Retired
Treasurer's occupation (required):
Bank or Financial Institution: Bank name (required): 1�m y .,
(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 offidal candidate
committee and authorize it to receive/make contributionstexpenditures 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.
§§ 16-9131 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.
r^
Chairperson's signature.aL� Date:
Treasurer's signature: Date: /Li 2 L
Candidate's signature (if applicable):
Date:
Arizona Secretary of State Revision 1115!16