HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - First Responders for a Safe Glendale - 6/2/2020CITY OF GLENDALE
❑✓ Initial Application
STATE OF ARIZONA COMMITTEE ID NUMBER
❑Amended Application = COMMITTEE STATEMENT (office use only)
Date:
OF ORGANIZATION 90-0-3
f
COMMITTEE TYPE (choose one):
❑ Candidate
Committee Name (required): First Responders for a Safe Glendale
(first or last name & office)
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): ❑ Governor ❑ Secretary of State ❑ Attorney General ❑ State Treasurer
❑ Superintendent of Public Instruction ❑ State Mine Inspector ❑ Corporation Commissioner
❑ State Senate ❑ State House of Representatives ❑ District (required):
❑ County Office:
❑ District (if applicable):
❑ City/Town Office: []District (if applicable):
Election Cycle for Office Sought (year the election will take place) (required):
Party Affiliation: NSA ❑ Democrat ❑ Green ❑ Libertarian ❑ Republican ❑ Other:
(required for partisan offices)
❑ Political Action Committee (PAC)
Committee Name (required): First Responders fora Safe Glendale
(if sponsored, must include
sponsor's name)
Political Function (optional): []Contributions ❑✓ Candidate -Related Independent Expenditures
(select any that apply) ❑ 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 []Separate Segregated Fund of a Corporation, LLC, Partnership, or Union
(if applicable) ❑ Standing 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
First Responders for a Safe Glendale
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
r3
I'T'I
Initial Application STATE OF ARIZONA COMMITTEE ID NUMBEF
Amended Application COMMITTEE STATEMENT (office use only)
are OF ORGANIZATION
C6.
AMrrTEE INFORMATION:
Contact Information:
Chairpersons Information:
Treasurer's Information:
Bar* or Furaridal InstiWon:
(do not Est aect numbers)
ItARAMN AND SIGNATURES:
Committee's mailing address (required): 61 E Columbus Ave. Phoenix, AZ 8501 er
Committee's email address (required): SafeGlendale@gmail.Com
Committee's phone number (if any) -
Committee's website (if any):
Chairperson's name (required)
Michael Colletto
Chairperson's physical address (required): 5710 W Monona Dr. Glendale, AZ 853
Chairperson's mailing address (if different). mikecollettopffa@g mail.Com
Chairperson's email address (required):
Chairperson's phone number (required): 602-881-0544
Chairperson's employer (required): None
Chairperson's occupation (required): Retired
Treasurer's name (required): Bryan Willingham
Treasurer's physical address (required): 18871 N 73rd Dr. Glendale, AZ 85308
Treasurer's mailing address (if different):
Treasurers emalladdress (required): bwillingham@IOCal493.org
Treasurer's phone number (required): 602`828-2416
Treasurer's employer (required): City of Phoenix
Treasurer's occupation (required): Fire Captain
Bank name (required): Alliance Bank
Additional bank name ('inapplicable):
Additiorial bank name (if applicable): - --
1 declare under penalty of perjury that the foregoing information is true and correct. I further declare that 1: (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
comrrri;tee and authorize it to receivelmake contributions/expenditures on my behalf, if applicable; (3) have read the Secretary of State's
r�rrtpafgn finance and reporting guide; (4) agree to comply with Arizona election law, including campaign finance laws codified at A.R.S.
§§ 76-90I 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.
I �
Charrperson's signature: '
Treasurers signature:
Candidate's SIgnasure f� app icable):
Date.— ' 7t�
Date: -5---30
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