HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Glendale Chamber PAC - 6/21/2024O Inkial Application STATE OF ARIZONA
13 Amended Application '<,., _ COMMITTEE STATEMENT
Date: OF ORGANIZATION
COMMITTEE TYPE (choose one):
O Candidate
Committee Name (required):
(first or last name 8 office)
Candidate Information:
Candidate's Name (required):
Candidate's mailing address (required):
Candidate's email address (required): _
Candidate's phone number (required): -
Candidate's websits (if any):
Office Sought (choose one): O County Office:
OCity/Town Office:
O School Board Office:
19 Special District Board:
ElDistrict (if applicable):
ODlstrict (if applicable):
O District (if applicable):
O District (if applicable):
Election Cycle for Office Sought (year the election will take place) (required):
PartyAffif/ation: O Democrat O Green 19 Libertarian O Republican O Other:
(required for partisan offices)
COMMITTEE ID NUMBER
(office use ony)
Political Action Committee (PAC) r I_ I-
Committee Name (requiredr
t7 1 e f7 da It- Ch CA al h N 0
(if sponsored, must include
sponsors name)
Political Function (optional):
/
Contributions M Candidate -Related Independent Expenditures
(select any that apply)
Measure Expenditurest Recall Expenditures
Sponsorship Information:
Sponsor's name or nickname (required): /FY
(if applicable)
Sponsor's mailing address (required):
Sponsor's email address (required):
Sponsor's 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)
D Mega PAC (must provide proof of Mega PAC status to filing officer) (amended applications only)
O Political Party
Committee Name (required):
(must include party affiliation)
Jurisdiction:
Special Status
(if applicable)
O State Party (must include proof of qualification pursuant to A.R.S. § 16-801 or § 16-804)
O County Party (must include proof of qualification pursuantto A.R.S. § 16-802 or § 16-804)
O Legislative District Party (must include proof of organization pursuant to A.R.S. § 16-823)
O City or Town Party (must include proof of qualification pursuant to A.R.S. § 1 M02 or § 16-804)
O Standing Committee (must also complete separate standing committee registration)
Arizona Secretary of State Revision 7/2912021
13 Initial Application ' STATE OF ARIZONA
17 Amended Application COMMITTEE STATEMENT
Date: OF ORGANIZATION
COMMITTEE INFORMATION:
COMMITTEE ID NUMBER
(office use only)
Contact Information:
Committee's mailing address (required): y ri 9 4
u/ Ca vNel b rr k Lf t; r�r- ,,7 - ..7 y
/
Committees email address (required): _ lea a'✓tot
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Committee's phone number (rr any): fc, 1 3 - q i
;- <f 7,y�
Committee's website (if any): G l D e Li a t e r„ r
i m be /' o al. L'rM
Chairperson's Information:
Chairperson's name (required): l 'rr ✓hA G
V e S C 1 R
Chairperson's physical address (required): 9/J/7
/V `7 1±17 61e j I d,R
Chairperson's mailing address (if different):
Chairperson's email address (required): / )/ o S
c, a Co, / o i/=c(n ra /,
Chairperson's phone number (required):
//t ^C2,44 rr eerrg2
__ _ _ _-A - ( 2.3 '04I
r�
Chairperson's employer (required): 5 P // j G
(j/1 i)T� e [I
Chairperson's occupation (required): a -i ,, A
YI e I/
Treasurer's Information:
Treasurers name (required): Y V () 4 r7 -�P—
J. Ll ✓I G A
Treasurers physical address(required):
Treasurers mailing address (if different):
Treasurers email address (required): 'i/m<</ a n vt -0
I�
. Y ✓r a a. c K !d Gi ei-In a [ ar✓!
Treasurers phone number (required):
Treasurersemployer(required): Ke
Treasurersoccupation(required): ge-LA=I�
re
Bank or Financial Institution:
Bank name (required): I ,l IO II S R
U A I , a 0'(,�
(do not list acct numbers)
Additional bank name (If applicable):
Additional bank name (if applicable):
5IX03I_1:1191*1el-1C1111]Mleier aIIIKI Z&R
I declare under penalty of perjury that the foregoing information is true and correct. I further declare that C (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 contributionstexpenditures on my behalf, if applicable; (3) have mad the Secretary of States
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 nolificalions and legal service of process for campaign finance purposes via the email
address(es) provided herein.
Chairperson's signature:",- 2an /itio Date: "//°' ll- f 2q
Treasurer's signature: (� . � «A� Date: lP o7 t7 -7d
Candidate's signature (if applicable):
Date:
0
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Arizona Secretary of State Revision 7/29/2021