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HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Protect Glendale - 8/29/2024'224AUG 9PM 50C1Tr (._i EFL:. ® InitialApplication STATE OF ARIZONA O Amended Application ' �: COMMITTEE STATEMENT Date; 08/29/2024 OF ORGANIZATION COMMITTEE TYPE (choose one): O Candidate Committee Name (required): (first or last name & 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): O CountyOffice: 13Citylfown Office: O School Board Office: 19 Special District Board: Election Cycle for Office Sought (year the election will take place) (required): F9District (if applicable): ODistrict (if applicable): O District (if applicable): ©District (if applicable): Party Affiliation: O Democrat O Green O Libertarian O Republican O Other (required for partisan offices) O Political Action Committee (PAC) Committee Name (required): Protect Glendale (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: (if applicable) special Status (if applicable) O Political Party Committee Name (required): (must include party affiliation) Jurisdiction: 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): . COMMITTEE ID NUMBER (office use only) ❑ 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) Cl State Party (must include proof of qualification pursuant to A.R.S. § 16-801 or § 16-804) © County Party (must include proof of qualification pursuant to 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. § 16-802 or § 16-804) O Standing Committee (must also complete separate standing committee registration) Arizona Secretary of State Revision 7/29/2021 El Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER 13 Amended Application COMMITTEE STATEMENT (office use only) Date: 08/29/2024 OF ORGANIZATION o r COMMITTEE INFORMATION: Contact Information: Committee's mailing address (required): 5025 N 81st Drive, Glendale AZ 85303 Committee's email address (required): cq@grassrootspartners.com Committee's phone number (if any): Committee's website (if any): Chairperson's Information: Chairperson's name (required): Jerry Weiers Treasurer's Information: Bank or Financial Institution: (do not list acct numbers) DECLARATION AND SIGNATURES: Chairperson's physical address (required): 5025 N 81 st Drive, Glendale AZ 85303 Chairperson's mailing address (if different): Chairperson's email address (required): sweiers@cox.net Chairperson's phone number (required): (602) 677-0755 Chairperson's employer (required): City of Glendale Chairperson's occupation (required): Mayor Treasurer's name irenuireril- Constantin Querard Treasurer's physical address (required): 13618 W Denton St, Litchfield Park AZ 85340 Treasurer's mailing address (if different): Treasurer's email address (required): cq@grass rootspartners.com Treasurer's phone number (required): (480) 703-8145 Treasurer's employer (required): Seld Treasurer's occupation (required): Consultant Bank name (required): Bank of America 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 accept all notifications and legal service of process for campaign finance purposes via the email address(es) provided herein. Chairperson's signature:1_ Treasurer's signature: C� _ Candidate's signature (if applicable): Date: 08/29/2024 Date: 08/29/2024 Date: Arizona Secretary of State Revision 7/29/2021