HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Lupe Encinas for Council - 3/1/2023O Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER
13 Amended Application - COMMITTEE STATEMENT (off use only)
Data: .23 - O3
OF ORGANIZATION
COMMITTEE TYPE (choose one):
)<Candidaie Cout"%cl
tee Name (required): � Y�V
(first or last name & offioe)
Candidate Information: Candidate's Name (required):
Candidate's mailing address (required):
Candidate's email address (required):' t l�
Candidate's phone number (required):
Candidate's website (if any): !v I N
Office Sought (choose one): 0 County Office: 413iistrict (if applicable): U
OfficeCilylfown O�Dstrict (if applicable):
0 School Board Office: 0 DWd (if applicable):
0 Special District Board: MDfstrict (if applicable): �7
Election Cycis for Office Sought (year the election will take place) (required):PM A � G-4
e` Party Affiliation: Democrat G Green 0 libertarian O Republican 0 Other.
(required for partisan offices)
0 Political Action Committee (PAC)
Committee Name (required):
(if sponsored, must include
sponsors name)
Political Fundbn (optional): ❑ Contributions ❑ Candidate -Related Independent Expenditures.
(select any that apply) ❑ Ballot Measure Expenditures ❑ Recall Expenditures
Sponsorship Infatuation: Sponsors name or nickname (required):
(if applicable) Sponsors mailing address (required):
Sponsors email address (required):
Sponsors phone number (if any):
Sponsors 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)
0 Political Party
Comrretlse Name (required): _
(must include party afffi'iation)
Judsdk4on. 0 State Party (must include proof of qualification pursuant to A.R.S. § 16-801 or § 164304)
0 County Party (must include proof of qualification pursuant to A.R.S. § 16-802 or § 16-604)
E Legislative District Party (must include proof of organization pursuant to A.R.S. § 16-823)
13 City or Town Party (must include proof of qualfication pursuant to A.R.S. § 16-M or § 16404)
Special Status 13 Standing Committee (must also complete separate standing committee registration)
(if applicable)
Arizona Secretary of State Revision 7f2g12D21
• Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER
® Ames Appkation COMMITTEE STATEMENT (off use only)
Date: OF ORGANIZATION
COMMITTEE INFORMATION:
Contact,nformatiorr:
Committee's mailing address (required):
Committee's email address (required):
Committee's phone number (d any):
*14
Committee's website (d any):
Chairpeison's Information: Chairperson's name (required): ttA4
Chairperson's physical address (required): r C &&Ie, Az,
Chairperson's mailing address (if different): 41
Chairperson's email address (required): iY Y�1 i'��{IG D LL&e. _ Wn
Chairperson's phone number (required)- y :? Li C3
Chairperson's employer (required): kr 41t hI
Chairperson's occupation (required)- l
Treasurer's Infar-n udon: Treasurer's name (required): .J Q
Treasurees physical address (required):
Treasurers mailing address (if different): G
Treasurer's email address (required): ry-1
Treasurers phone number (required):
Treasurers employer (required): 'e ' .
Treasurers occupation (required): 1 S
Bank or Financial Instit tn: Bank name (required): `V 1 I A ILI Y--, A— V—ra 0 � -
(do not fist acct numbers) Additional bank name Cif applicable):
Additional bank name (if applicable):
DECLARATION AND SIGNATURES:
1 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 Stews
campaign finance and reporting guide; (4) agree to comply with Arizona elecfion 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. _ �► (� 7
Chairperson's signature: ir1�X Date: ") • 1 Z
to ZoZ3
Treasurers signature: t • _'J 'r `� ' ' _ Date: _
Candidate's signature Cifapplicable : F ^+�Date:
Arzom Secretary of State Revision 7129/2021