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):
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Chairperson's physical address (required):
Chairperson's mailing address (if different):
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Chairperson's email address (required):
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Chairperson's phone number (required):
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Chairperson's employer (required):
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Chairperson's occupation (required)
Treasurer's Information:
Treasurer's name (required):
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Treasurer's physical address (required):
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Treasurer's mailing address (if different):
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Treasurer's email address (required):
Treasurer's phone number (required):
Treasurer's employer (required):
Treasurer's occupation (required):
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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
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Date:.
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Arizona Secretary of State Revision 7/29/2021