HomeMy WebLinkAboutPC2018-05 - Gerry Friedel for Town Council - Statement of Organization• Initial Application
•Amended Application
Date:
COMMITTEETYPE (choose one)
STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
COMMITTEE ID NUMBER
(office use only)
06-04-18A09:15 RCVD
•Candidate
Committee Name (required):
(first or last name &office)
Candidate Information:
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Candidate's Name (required):Q<3^^/r72~f ^)CC-
Candidate's mailing address (required):/J>Z</Lf /\J /fI^U/rf-frQO i/)fC.foW.
Candidate's email address (required):/^A c3fl<^Ge/^V £?f/HA-f't-,CO/(/]
Office Sought (choose one)
Candidate's phone number (required):_
Candidate's website (if any):
D Governor •Secretary of State
•Superintendent of Public Instruction
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•Attorney General
•State Mine Inspector
•State Treasurer
•Corporation Commissioner
•State Senate
•County Office:
•State House of Representatives • District (required):
• District (if applicable):
tefCity/Town Off\ce:COI#/l)CcL.$&Kflgj[^DDistrict (if applicable):
Election Cycle for Office Sought (year the election will take place)(required):A~UfUGfZ-Dj CQn?
•RepublicanPartyAffiliation:•Democrat
(required for partisan offices)
•Green •Libertarian •Other:
•Political Action Committee (PAC)
Committee Name (required):
(if sponsored,must include
sponsor's name)
Political Function (optional'
(select any that apply)
Sponsorship Information:
(if applicable)
Special Status
(if applicable)
•Contributions •Candidate-Related Independent Expenditures
•Ballot Measure Expenditures •Recall Expenditures
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
Committee Name (required):
(must include party affiliation)
Jurisdiction:
Special Status
(if applicable)
•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)
•Legislative District Party (must include proof of organization pursuant to A.R.S.§16-823)
• City or Town Party (must include proof of qualification pursuant to A.R.S.§16-802 or §16-804)
•Standing Committee (must also complete separate standing committee registration)
Arizona Secretary of State Revision 11/5/16
x Sr STATE OF ARIZONA COMMITTEE ID NUMBER
� Initial Application .
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❑ Amended Application y-�-�, ' COMMITTEE STATEMENT
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COMMITTEE INFORMATION:
Contactlnformation: Committee's mailing address (required): /.�l �� /Y •�L�/�'1i`-d'f� c��, ���'Ni:�s`U //ILFiS�7 (�
Committee's email address (required): �2i C�. _ 9P���/ ��M�� L r. C', J�
Committee's phone number (if any): (��3n^ 9i �%� �i ,�,�i''J
Committee's website (if any):
Chairperson's Information: Chairperson's name (required): ��' �y F� ``�CJ ��
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Chairperson's physical address (required): I.�Z�'� �V� /1 ���"� ��L- TrXa i • �(,� �5��'�
Chairperson's mailing address (if different):
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Chairperson's phone number (required): � ��ID - �%/ �Z - �I,� Zi0
Chairperson's employer (required): (� �,G.��rni
Chairperson's occupation (required): i�r�s7�
Treasurer's Information: Treasurer's name (required): d f-. Q � �� ���%C��
Treasurer's physical address (required) �Jr.��� �.. K� 1� �K���. �Oli�Ei/J� H��S,�z.
Treasurer's mailing address (if different):
Treasurer's email address (required): �IcG�„�'1KE �' !1J %f1,N{�. B.D��%�-
Treasurer's phone number (required): J'�.�T� .�o��� J`���.�
Treasurer's employer (required): R�,T /R�D
Treasurer's occupation (required):
Bank or Financia/ lnstitution: Bank name (required): �� �r /,2Jr �
(do not list acct numbers)
DECLARATION AND SIGNATURES:
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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:
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Treasurer's signature: ��' �<ls' !�� / �i �� �[�--
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Candidate's signature (if applicable): �;
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Additional bank name (ifapplicable):
Additional bank name (if applicable):
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Arizona Secretary of State Revision 11/5/16