HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Weiers 2024 - 5/2/2022M Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER
jigAmended Application COMMITTEE STATE M ENT (office use only)
Date: OF ORGANIZATION
COMMITTEE TYPE (choose one):
M Candidate
Corru Mee Name (required):
(first or last name S office)
Candidate Information:
Candidate's Name (required):
Candidate's mailing address (required): +Q
Candidate's email address (required):
Candidate's phone number (required): 0-1 :2 1 49Zi-
Candidate's website Of any):
Oh4ce Sought (choose one): 0 County Office:
ODistrict (if applicable):
OCity/Town Office: _ .y 1� ®District Of applicable): (y t e N J q /e
0 School Board Office:
0 Special District Board: _ _ .
19 District Of applicable):
®District (if applicable):
Election Cyde tar Office Sought (year the election will take place) (required): ti
Pw. yAWIatior. Aj 0 Democrat 0 Green 0 Libertarian 0 Republican 0 Other:
(required for ces)
0 Political Action Committee (PAC)
Committee Name (required): 44 r
Of sponsored, must include
sponsor's name)
Political Fund/orr (optional): O Contributions 0 Candidate -Related Independent Expenditures
(select any that apply) 0 Ballot Measure Expenditures 0 Recall Expenditures
Sponsorship Information:
Of 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 0 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)
0 Political Party
Committee Name (required): —
(must Include party affiliation)
Jurlsdktion: 0 State Party (must include proof of qualification pursuant to A.R.S. § 1 M1 or § 10-11%)
0 County Party (must include proof of qualification pursuant to A.R.S. § 18-802 or § its-804)
0 Legislative District Party (must Include proof of organization pursuant to AR.S. § 18-823)
13 City or Town Party (must Include proof of qualification pursuant to A-R.S. § 18-802 or § 18-804)
Spew Status M Standing Committee (must also complete separate standing committee registration)
(If applicable)
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Arizona Secretary of State Revision 7/29/2021
® Initial Application STATE OF ARIZONA 12 COMMITTEE ID NUMBER I
Amended Application COMMITTEE STATEMENT I (office use only)
Date OF ORGANIZATION _- _ _....__......!
COMMITTEE INFORMATION:
Contactlnforma0w. Committee's, mailing address (required): qju1� '�►j 7
Committee's email address (required):
CommNtee's phone number (If any): _
Committee's website (if any):
Chairperson's Information:
Chairperson's name (required):
Chairperson's physical address (required):
k 4 I
Chairperson's mailing address (if different):
Chairperson's email address (required):
Chairperson's phone number (required):
Chairperson's employer (required):
Chairperson's occupation (required):
Treasurer's Information:
Treasurer's name (required): ,_. f+6 C.4 �1.
2- A W.11
Treasurer's physical address (required): r► C
l�o�.itl • d 7 ftw
Treasurer's mailing address (If different):
Treasurer's email address (required):
eDw
Treasurer's phone number (required):
320
Treasurer's employer (required):
Treasurer's occupation (required): CIPA
Bw* or Financial 1nslitufion:
Banc name (required): A M j"
(do not list acct numbers)
Additional bank name (if applicable):
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
c ommittes and authorise It to rec&elmake cordributlone/expenditures on my behalf, If applicable; (3) have read the Secretary of State's
campaign finance and portin ulde; (4) ree to comply with Arizona election law, including campaign finance laws codified at A.R.S.
§§ 18-901 to 16-938; a• (5) a to a pall notficationp and legal service of process for campaign trance purposes via the email
address(es) provided he j
Chairperson's signature: _ l �Z.•.
Treasurer's signature: � Date: 0 S`— D 2' 2 D 2 Z
Candidate's signature (if applicable):y Date:
Arizona Secretary of State Revision 7QW021