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HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Michelle Robertson for Mayor - 3/3/2020Initial Application Amend Ap lication Date: l� COMMITTEE TYPE (choose one): fi [candidate Committee Name (required) (first or last name & office) Candidate Information: CITY OF GLENDALE STATE OF ARIZONA COMMITTEE STATEMENT OF ORGANIZATION COMMITTEE ID NUMBER (office use only) a©--0/ Candidate's Name (required): t""' i v O l/) Candidate's mailing address (required): LV S - eo Je,.J Z Candidate's email address (required): i CLL1l, ayVl1 ����C f 01- yle�' Jnr Candidate's phone number (required): 6 Z,3 _ b Z Candidate's website (if any): M i G a vk ok. Qw� Office Sought (choose one): ❑ Governor ❑ Secretary of State ❑ Attorney General ❑ Superintendent of Public Instruction ❑ State Mine Inspector ❑ State Senate ❑ State House of Representatives ❑ County Office: ❑ State Treasurer ❑ Corporation Commissioner ❑ District (required): ❑ District (if applicable): ACityrrown Office: P'Ira l []District (if applicable): Election Cycle for Office Sought (y r the election will take place) (required): 2. C> Party Affiliation:N/ Democrat ❑ Green ❑ Libertarian ❑ Republican ❑ Other: (required for partisan offices 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) 11 Ballot Measure Expenditures 0 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) 0Standing Committee (must also complete separate standing committee registration) Mega PAC (must provide proof of Mega PAC status to filing officer) (amended applications only) 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 Tr Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER Amendep Application COMMITTEE STATEMENT (office use only) Date: 3 O OF ORGANIZATION COMMITTEE INFORMATION: Contact Information: Committee's mailing address (required): t (,? " 1 Committee's email address (required): 111 @ 't7VYIAV92iOM Committee's phone number (if any): Committee's website (if any): ,, 1M��-�� T im�yof•cl Chairperson's Information: name (required): r ( Chairperson's physical address (required): ((6 [v el 5 u E✓ � , � "" (� iG. Treasurer's Information: Bank or Financial Institution: (do not list acct numbers) DECLARATION AND SIGNATURES: Chairperson's mailing address (if different): 11 _ e Chairperson's email address (required): Y1n Ll -j IP im yy , Z t 16 tMA V[ (�o`o Chairperson's phone number (required): ZI ' -2, Ll C) 7— 7 Z q 2 ri Chairperson's employer (required): .. i" -Ac w l Chairperson's occupation (required): Diet ��1 [A +0 Treasurer's name (required): (le Treasurer's physical address (required): [ �, u� �j 1 S ua, A t-- a le &L I Treasurer's mailing address (if different): Treasurer's email address (required): MI ii ii q Gt,t �Q ,�Lj I Cha-�� VVIGttp,�y� Treasurer's phone number (required): L 6" 7 Treasurer's employer (required): Treasurer's occupation (required): ,4 a -r _ Bank name (required): Lj e:> Additional bank name (ifapplicable): Additional bank name (if applicable): 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 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. §§ 16-901 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. ' r Chairperson's signature: e Date: - 9 ' C)2- Treasurer's signature: Date: onap Candidate's signature (if applicable Date: �• � • Arizona Secretary of State Revision 11/5/16