HomeMy WebLinkAboutStatement of OrganizationCITY /TOWN OF
POLITICAL COMMITTEE
STATEMENT OF ORGANIZATION
Titles 16 &19 Arizona Revised Statutes
Definitions,statutory references and important information on reverse.
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nitial Registration •Out of State Committee D Amended Statement
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NAME OF POLITICAL COMMITTEE
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ADDRESS (NUMBER &STREET)CITY
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STATE
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ZIP
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MAILING ADDRESS (Ifdifferent from above)CITY STATE ZIP
COMMITTEE TELEPHONE #COMMITTEE FAX #COMMITTEE E-MAIL ADDRESS
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DOES THE POLITICAL COMMITTEE HAVE A SPONSORING ORGANIZATION?
Ifyes,please provide the following information:
1 YES ^/NO
NAME OF SPONSORING ORGANIZATION TYPE OF ORGANIZATION
ADDRESS OF SPONSORING ORGANIZATION RELATIONSHIP TO POLITICAL COMMITTEE
TYPE OF POLITICAL COMMITTEE -Please check only one box:
^•CANDIDATE'S CAMPAIGN COMMITTEE (primary or general)
SEPARATE SEGREGATED FUND (A.R.S.§16-920 (A))
•
•
•
•
AN ASSOCIATION OR COMBINATION OF PERSONS THAT CIRCULATES
PETITIONS IN SUPPORT OF THE QUALIFICATION OF A BALLOT MEASURE
Petition Serial Number
AN ASSOCIATION OR COMBINATION OF PERSONS THAT CIRCULATE A
RECALL PETITION
POLITICAL PARTY (see A.R.S.§§16-801, 16-804,16-821 and 16-825)
AN ASSOCIATION OR COMBINATION OF PERSONS THAT
MEETS BOTH CRITERIA:
1.IS ORGANIZED,CONDUCTED OR COMBINED FOR THE
PRIMARY PURPOSE OF INFLUENCING THE RESULTS OF ANY
ELECTION;AND
2.KNOWINGLY RECEIVES CONTRIBUTIONS OR MAKES .
EXPENDITURES OF MORE THAN $500 IN CONNECTION WITH
ANY ELECTION DURING A CALENDAR YEAR.
POLITICAL ORGANIZATION (see A.R.S.§16-823)
EXPLORATORY COMMITTEE
OTHER TYPE OF COMMITTEE (please describe)
D;HECK HERE IF REGISTERED WITH THE SECRETARY OF STATE AS A STANDING POLITICAL COMMITTEE PURSUANT TO A.R.S.§16-902.01.
(Youmust provide a copy of the statement of organization filedwiththe Secretary of State designating standing committee status)
EACH POLITICAL COMMITTEE SHALL HAVE A CHAIRMAN AND TREASURER.THE POSITION OF CHAIRMAN AND TREASURER OF A SINGLE
POLITICAL COMMITTEE MAY NOT BE HELD BY THE SAME INDIVIDUAL,EXCEPT THAT A CANDIDATE MAY BE CHAIRMAN AND TREASURER OF
HIS OR HER OWN CAMPAIGN COMMITTEE.A.R.S. §16-902(A).
NAME OF COMMITTEE CHAIRMAN
CHAIRMAN'S ADDRESS
CHAIRMAN'S OCCUPATION
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NAME OF COMMITTEE TREASURER
TREASURER'S ADDRESS
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TREASURER'S OCCUPATION
CHAIRMAN'S TELEPHONE #
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CITY
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CHAIRMAN'S EMPLOYER
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TREASURER'S TELEPHONE #
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CITY
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TREASURER'S EMPLOYER
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CHAIRMAN'S FAX #
STATE
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ZIP
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CHAIRMAN'S E-MAIL ADDRESS
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TREASURER'S FAX #
STATE
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ZIP
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TREASURER'S E-MALL ADDRESS
A POLITICAL COMMITTEE THAT ACCEPTS A CONTRIBUTION OR MAKES AN EXPENDITURE SHALL DESIGNATE AT LEAST ONE ACCOUNT AT A
QUALIFIED FINANCIAL INSTITUTION (A.R.S. § 16-902(C)). LIST THE NAMES OF ALL FINANCIAL INSTITUTIONS WITH WHICH THE COMMITTEE
MAINTAINS ACCOUNTS OR SAFETY DEPOSIT BOXES. (Do not list account numbers.)
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FOR AN EXPLORATORY COMMITTEE OR A CANDIDATE'S CAMPAIGN COMMITTEE, PROVIDE THE FOLLOWING INFORMATION:
(Office sought is optional for an Exploratory Committee.)
NAME OF DESIGNATING INDIVI UFjL (DI) OR CANDIDATE
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OFFICE SOUGHT
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DI's OR CANDIDATE'S ADDRESS
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CANDIDATE'S OR DESIGNATING INDIVIDUAL'S E-MAIL ADDRE S
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C�TY �. STATE ZIP
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CANDIDATE'S (or DESIGNATING INDIVIDUAL'S) STATEMENT: I authorize the above-named political committee as my political committee to receive
contributions and make expenditures on my behalf for the election in 2016.
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Date: _�� / J l/�_ Candidate's or D/I's signature: ,� /1�--��i �C/!�`�—y"'�v��
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CHAIRMAN'S AND TREASURER'S STATEMENT: We, the undersigned, pursuant to A.R.S. § 16-902.01(86) have read all the appiicable laws relating to
campaign finance and reporting and have examined the information contained in this statement of organization and, to the best of our knowledge and belief,
it is true �orf� ct,e� d complete. / r nG /� %��
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Date: " / /. � Chairman's signature: . � ' � C�
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Date: �/` � Treasurer's signature: �
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DEFINITION OF POLITICAL COMMITTEE: AR.S. § 16-901(19) "Political committee" means any of the following:
a) A candidate or a candidate's campaign committee.
b) A separate, segregafed fund established pursuant to section 16-920, subsection A, paragraph 3.
c) An association or combination of persons that circulates petitions in support of the qualification of a ballot measure, question or proposition.
d) An association or combination of persons that circulates a petition to recall a public officer.
e) A political party.
fl An association or combination of persons that meets both of the following requirements:
i. Is organized, conducted or combined for the primary purpose of influencing the result of any election in this state or in any county, city, town or
other political subdivision in this state, including a judicial retention election.
ii. Knowingly receives contributions or makes expenditures of more than five hundred dollars in connection with any election during a calendar year,
including a judicial retention election.
g) A political organization.
h) An exploratory committee.
The types of political committees are listed on the front of this form.
NOTE FOR INDIVIDUALS INVOLVED IN POLITICAL ACTIVITIES: An individual acting alone, unless that individual is a candidate, is not a political committee
under Arizona law and need not file a statement of organization. If any additional person or persons join the effort begun by an individual and meets the
definition of a"political committee" in A.R.S. § 16-901(19) under Arizona law, the committee must register pursuant to A.R.S. § 16-902.01(A).
NOTE FOR THOSE INVOLVED IN INITIATIVE, REFERENDUM AND RECALL EFFORTS: Before circulating initiative, referendum or recall petitions, a political
committee must file its statement of organization with the appropriate filing office. Signatures obtained on petitions prior to the filing of the statement of
organization are void and shall not be counted in determining the legal sufficiency of the petition. A.R.S. §§ 19-114(B) and 19-202(C). Even though an individual,
acting alone, may begin the initiative, referendum or recali effort, as soon as other persons join the effort to circulate petitions in support of the effort, the
association of persons must register as a political committee.