HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Patty Ortega for Council - 2/27/2023SrltNA COMMITTEE ID NUMBER
Q Amended Application - COMMITTEE STATEMENT (office use only)
Date: s?' OF ORGANIZATION -
COMMITTEE TYPE (choose one):
0 Candidate
Committee Name (required):
(first or last name & office)
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Candidate Information:
Candidate's Name (required): ('L 1'1f�[0�fGiDl.
Candidate's mailing address (required): _ �Og1�Z'�
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Candidate's email address (required): tL-"._*i
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Candidate's phone number (required):
Candidate's website (if any):
Office Sought (choose one):
0 County Office:
16istrict (if applicable): 1 �/ 1) CCc,
OCityfTown Office:
BDistrict (if applicable):
0 School Board Office:
0 District (if applicable):
El Special District Board:
ElDistrict (if applicable):
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Election Cycle for Office Sought (year the election will take place) (required):
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Party Affiliation:
0 Democrat 0 Green 0 Libertarian
0 Republican 0 Other:
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(required for partisan offices)
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0 Political Action Committee (PAC)
Committee Name (required):
1
(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)
Special Status
(if applicable)
0 Political Party
Committee Name (required):
(must include party affiliation)
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):
❑ Separate Segregated Fund of a Corporation, LLC, Partnership, or Union
❑ Standing Committee (must also complete separate standing committee registration)
❑ Mega PAC (must provide proof of Mega PAC status to filing officer) (amended applications only)
Jurisdiction: 0 State Party (must include proof of qualification pursuant to A.R.S. § 16-801 or § 16-804)
0 County Party (must include proof of qualification pursuant to A.R.S. § 16-802 or § 16-804)
0 Legislative District Party (must include proof of organization pursuant to A.R.S. § 16-823)
0 City or Town Party (must include proof of qualification pursuant to A.R.S. § 16-802 or § 16-804)
Special Status 0 Standing Committee (must also complete separate standing committee registration)
(if applicable)
Arizona Secretary of State Revision 7/29/2021
• Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER
• Amended Application COMMITTEE STATEMENT (office use only)
Date:
OF ORGANIZATION
COMMITTEE INFORMATION:
Contact Information: Committee's mailing address (required): (Pq 2-1 r,4 • .5 053o
Committee's email address (required): V, C-CY."
Committee's phone number (if any): 6ri-!5r • i,p O 2 • 2-4-5 1 4 O C
Committee's website (if any):
Chairperson's information: Chairperson's name (required): O� 6L, ,,� �!nI
Chairperson's physical address (required): b1Z Z� �� PCB t4 -, $53v
Treasurer's Information:
Bank or Financial Institution:
(do not list acct numbers)
DECLARATION AND SIGNATURES:
Chairperson's mailing address (if different):
Chairperson's email address (required): a l:.i 0 a.
Chairperson's phone number (required): O Z 2-4 S' 1`% 6 0
Chairperson's employer (required):n _ ✓ W " l l "
Chairperson's occupation (required): __ f`--
Treasurer's name (required): _ G"CtZt Q AU 6-1
Treasurer's physical address (required): i�p 8 L� 1�-ti� 0 P�Z g-530
Treasurer's mailing address (if different):
Treasurer's email address (required): A- t o • C-0—
Treasurer's phone number (required):
Treasurer's employer (required):-��-✓ L��� �`► rf �''1S
Treasurer's occupation (required): Bank name (required): I� �GLr1 k- (� I ;,,4� Ilex _
Additional bank name (if applicable):
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 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) ague to accept all notifications and legal service of process for campaign finance purposes via the email
address(es) provided herein. 7 f ,
Chairperson's signature: _ . Q Date: Z, ?-1- 23
Treasurer's signature: Date: 211 - Z 3
Candidate's signature (if applicable): 1- !- �! Date: 1- 12 2-3
Arizona Secretary of State Revision 7/29/2021