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HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Moving Glendale Forward - 7/2/2024Initial Application SAI. OF ARIZONA COMMITTEE ID NUMBER © Amended Application COMMITTEE STATEMENT (office use only) Date: { OF ORGANIZATION a� _ J COMMITTEE TYPE (choose one): 13 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 website (if any): Office Sought (choose one): 13 County Office: ©District (if applicable): ClCitylTown Office: ©District (if applicable): © School Board Office: p District (if applicable): 13 Special District Board: t7District (if applicable): Election Cycle for Office Sought (year the election will take place) (required): 1 Party Affiliation: CI Democrat 13 Green 19 Libertarian 13 Republican El Other: (required for partisan offices) © Political Action In Comittee (PAC) t7 N I !_ � t�� F� W �� Committee Name (required): (if sponsored, must include sponsor's name) Political Function (optional): 4�]-a7ltributions -Et'irandidate-Related Independent Expenditures (select any that apply) t3"�a lot Measure Expenditures 9-Recall Expenditures Sponsorship Information: (if applicable) Special Status (if applicable) 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) © Political Party r Committee Name (required): (must include party affiliation) Jurisdiction: CI State Party (must include proof of qualification pursuant to A.R.S. § 16-801 or § 16-804) 13 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) 13 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 0 Amended Application COMMITTEE STATEMENT (office use only) Date: OF ORGANIZATION)q—OQL COMMITTEE INFORMATION: Contact Information: Committee's mailing address (required): C��, l �._4 P` 4r1L t.fn l�Y� /'►tC Committee's email address (required): s 6-TA a f4 a M N - Committee's phone number (if any): Committee's website (if any): Chairperson's Information: Chairperson's name (required): oo_ 5 � -mc o, 5 Chairperson's physical address (required): F41 t}S{ R9,4AL Phb! L R` >_ 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): A179-T B 6T-0- CNIFil, G (V\5 A.CCPI '1 Chairperson's phone number (required): AoZ tc)) Chairperson's employer (required): 4 t�-tJ U LTT fJ t^y F P �,*U) Chairperson's occupation (required): aot4 iSJL-r)4_ - r Treasurer's name (required): Treasurer's physical address (required): Z. Z Treasurer's mailing address (if different): G&Ncp. Treasurer's email address (required): 4 I t Treasurer's phone number (required): _1_00;4-^ `X- S2` Treasurer's employer (required):��\ Treasurer's occupation (required): Bank name (required): Kn5 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) agree to a9cept all notifications and legal service of process for campaign finance purposes via the email address(es) provided herein. � „ Chairperson's signature: ��� v�"� Date: i ^ 2�20 �, y Treasurer's signaturJL� Date: Candidate's signature (if applicable): Date: Arizona Secretary of State Revision 7/29/2021