HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Protect Neighborhoods Now - 6/25/2020CITY OF GLENDALE
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Initial Application STATE OF ARIZONA
❑Amended Application COMMITTEE STATEMENT
Date: 6-25-2020 OF ORGANIZATION
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COMMITTEE TYPE (choose one):
Candidate
Committee Name (required):
j (first or last name $ office)
COMMITTEE ID NUMBER
(office use only)
0
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 ('d applicable):
❑ City/Town Office: ❑District (if applicable):
Election Cycle for Office Sought (year the election will take place) (required):
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❑ pemocrat❑Green ❑Libertarian ❑Republican ❑Otherpaisan
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offices)
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® Political Action Committee (PAC)
Committee Name (required):
Protect Neigbhnrhnndc Nnw
(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:
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)
Standing Committee (must also complete separate standing committee registration)
0 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
Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER
Amended Application COMMITTEE STATEMENT (office use only)
Date: 11 r OF ORGANIZATION -1 ^0
COMMITTEE INFORMATION:
Contact Information:
Committee's mailing address (required): 6311 N. 172nd Lane, Waddell, A7. R5355
Committee's email address (required): katmckinney1agmail.com
Committee's phone number (if any): 602-390-2687
Committee's website (if any):
Chairperson's Information:
Chairperson's name (required): KathM McKinney
Chairperson's physical address (required): 6311 N. 172nd Lane, Waddell. AZ 85355
Chairperson's mailing address (if different):
Chairperson's email address (required): katmckinne� 1 `a,, mail.com _
Chairperson's phone number (required): 602-390-2687
Chairperson's employer (required): none
Chairperson's occupation (required): retired
Treasurer's Information:
Treasurer's name (required): Tim❑
Treasurer's physical address (required): 303 W- Ctella Lane, Phoemix, 1�7- 85013
Treasurer's mailing address (if different):
Treasurer's email address (required): tim@timlasota.Com
Treasurers phone number (required): 602-515-2649
Treasurer's employer (required): Timothy A. La Sota, PL
Treasurer's occupation (required): attorne
Bank or Financial Institution:
Bank name (required): Ranl-nf AmPriCa
t (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 k- nal service of process for campaign finance purposes via the email
address(es) provided herein.
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Chairperson's signature: Date:
}x'11
Treasurer's signature: Date:
Candidate's signature (if applicable):
Date:
Arizona Secretary of State Revision 11/5/16