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HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Elect Dianna Guzman - 9/25/2023Initial Application ® Amended Application Date: COMMITTEE TYPE (choose one): 0 Candidate Committee Name (required): (first or last name & office) Candidate Information: STATE OF ARIZONA ! COMMITTEE ID NUMBER COMMITTEE STATEMENT (office use only) OF ORGANIZATION Candidate's Name (required): N C N r L Candidate's mailing address (required): V Candidate's email address (required): Candidate's phone number (required): Candidate's website (if any): Office Sought (choose one): lI County Office: DDistrict (if applicable): 11 ClCity/Town Office: , T 0 District (if applicable): 0 School Board Office: 0 District (if applicable): 0 Special District Board: aDistrict (if applicable): Election Cycle for Office Sought (year the election will take place) (required): ��LT Party Affiliation: 0 Democrat 0 Green 0 Libertarian 0 Republican 0 Other: (required for partisan offices) 0 Political Action Committee (PAC) Committee Name (required): (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) ❑ 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) 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 0 Initial at II Application STATE OF ARIZONA COMMITTEE ID NUMBER 0 Amended Application COMMITTEE STATEMENT (office use only) Date: OF ORGANIZATION COMMITTEE INFORMATION: Contact Information: Committee's mailing address (required): O � t C V. Committee's email address (required): c J3d3 .1 Committee's phone number (if any): O Committee's website (if any): Chairperson's Information: Chairperson's name (required): �+ kx\ � ly,� loc) Chairperson's physical address (required): Chairperson's mailing address (if different): 5 F 3� Chairperson's email address (required): A— to, 1 Chairperson's phone number (required): 60 ` �1S ' Chairperson's employer (required): I Chairperson's occupation (required) Treasurer's Information: Treasurer's name (required): t—� �`(, Treasurer's physical address (required): �� , 1� T Q(, �— ) S 853� Treasurer's mailing address (if different): i if _ Treasurer's email address (required): Treasurer's phone number (required): Treasurer's employer (required): Treasurer's occupation (required): CL t f Bank or Financial Institution: Bank name (required): (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 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 legal service of process for campaign finance purposes via the email address(es) provided herein(` Chairperson's signatu Treasurer's signature: Candidate's signature Date: �C/13 Date: 9 LJ�Z3 Date:. i— Arizona Secretary of State Revision 7/29/2021