HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Conchas for Glendale Mayor - 5/12/202619� Initial Application \ STATE OF ARIZONA
0 Amended Application I 1, COMMITTEE STATEMENT
Date: OF ORGANIZATION
COMMITTEE TYPE (choose one):
COMMITTEE ID NUMBER
(office use only)
,* — 0
0 Candidate Committee Name (required): n' on ch aS -g rGlwcialg _a_!o r-
(frst or last name & office) �J —�^
Candidate Information: Candidate's Name (required): U-03le- eyald 1d, Can do a ' Y.
Candidate's mailing address (required): KIwYON5 W - NAarle�-l-e_ Ave, CaLenala(2
L Candidate's email address (required): pe (-,11 Leymcp cji. as. C-Owl
Candidate's phone number (required): Caoai, - Ca, - 6!jp 9
Candidate's website (if any):
Office Sought (choose one): 0 County Office: 113District (if applicable):
X-Jty/Town Office: ODistrict (if applicable):
0 School Board Office: ® District (if applicable):
0 Special District Board: ODistrict (if applicable):
Election Cycle for Office Sought (year the election will take place) (required): Aoag
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)
El Political Party
Committee Name (required):
(must include party affiliation)
Jurisdiction:
Special Status
(if applicable)
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)
10 Standing Committee (must also complete separate standing committee registration)
W
Arizona Secretary of State Revision 7/29/2021
l Initial Application
'=_<: �. STATE OF ARIZONA
COMMITTEE ID NUMBER
El Amended Application
Date:
_ COMMITTEE STATEMENT
(office use only)
OF ORGANIZATION
COMMITTEE INFORMATION:
W MakW Ayr-
G h '35 I
Contact Information:
Committee's mailing address (required): 7-10A5 Ce
Committee's email address (required): Wp?,CA oL%
. c-b yy\
Committee's phone number (if any): (OC9 ' 31a ' 590(31
Committee's website (if any):
Chairperson's Information:
/� 1
Chairperson's name (required): Tom GLaJ&1up!E_ K A
a-c �l -T
Chairperson's physical address (required):. W • KL(kLQA+,g
fi�r.^
4'6 L7�Q11r��2 0��
ff ll '>`IA45✓
Chairperson's mailing address (if different): "Ls NN �
NZ G �x-�"e�(ILk. 853b
'
Chairperson's email address (required): L.ulpe ® 1;i4 Ayy
&C cA YY\
Chairperson's phone number (required): (9Qa' &12► ' Sq 097
Chairperson's employer (required): l7N E aM.
Chairperson's occupation (required): 1
Treasurer's Information:
Treasurer's name (required): OS2 Gli
Treasurer's physical address (required): �4a�J W l�GliC�t�°_
f-C1lr✓yllltY[CX 3��
Treasurer's mailing address (if different):
Treasurer's email address (required):
C11Y1r1
Treasurer's phone number (required): (qua • '3 1
Treasurer's employer (required): XJ� Dacia C a aQ. IQ
��a10X
Treasurer's occupation (required): ON1J CD MPQA0�1L
'—
BankorFinanciallnstitution:
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 signatur
Treasurer's signature:
Candidate's signature (
Date: / 2
.� rn Date: r t OZ L;;L u
if applicable): Date: r' ` I a JXD
Arizona Secretary of State Revision 7/29/2021