HomeMy WebLinkAboutPC2018-07 - Sharron Grzybowski - Amended Statement of Organzation• Initial Application
|0 Amended Application
Date:(JL/t/zmA
COMMITTEE TYPE (choose one):
tf Candidate
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STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
06-07-1 8P02:41 RCVD
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COMMITTEE ID NUMBER
(office use only)
Committee Name (required):
(first or last name &office)
Candidate Information:Candidate's Name (required):6M1OLfc
Candidate's mailing address (required):/(S )r~>C>iO {r)l >S?Kj XV gg
Candidate's email address (required):v_y )f-\rr~C~^C^j
Candidate's phone number (required):kDO^>*sy I °f;7 W O
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Candidate's website (ifany):
Office Sought (choose one):•Governor •Secretary of State •Attorney General
D State Mine Inspector
•State Treasurer
•Corporation Commissioner•Superintendent of Public Instruction
•State Senate •State House of Representatives • District(required)
• County Office:O District(ifapplicable):
UKlTtA O District (if applicable):own Office:ffiCity/Ti '^lP
Election Cycle for Office Sought (year the election will take place)(required):dSpQ lr~>
PartyAffiliation:•Democrat • Green • Libertarian • Republican •Other:
(required for partisan offices)
D 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 D 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 (ifany):
Sponsor's website (ifany):
• Separate Segregated Fundofa Corporation,LLC,Partnership,or Union
• Standing Committee(mustalso complete separate standing committee registration)
• MegaPAC(must provideproofofMega PAC status to filing officer)(amended applicationsonly)
•Political Party
Committee Name (required):
(must include party affiliation)
Jurisdiction:
Special Status
(if applicable)
D State Party(must include proofof qualification pursuantto A.R.S.§16-801 or§16-804)
•County Party(must include proof of qualification pursuanttoA.R.S.§16-802 or§16-804)
•Legislative District Party(must includeproofoforganizationpursuant to A.R.S.§ 16-823)
•City or Town Party(must include proofof qualification pursuantto A.R.S.§ 16-802or§16-804)
D Standing Committee(mustalso complete separate standing committee registration)
Arizona Secretary of State Revision 11/5/16
0 Initial Application
� Amendjed Application
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COMMITTEE INFORMATION:
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STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANI�ATION
Contact Informatron:
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Committee's mailing address (required): �jQ�/ � (.� - �7`j�L�Q //'� j"(it� ?1,9'�1 � ¢�( �
Committee's email address (required): �'� ��GY"� i' � �+, �
Committee's phone number (if any): �Z'� S o % y i �� y� j 9�
COMMITTEE ID NUMBER
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Committee's website (if any):
Chairperson's Information: Chairperson's name (required): �.7('n � + �`' (��1 \ ��l 1
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Chairperson's physical address (required): �%O / � �) '' �i
Chairperson's mailing address (if different): � �
Chairperson's email address (required): S�. L���f I Z� � I /�-t �
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Chairperson's phone number (required): �n� o�(��/ c f��CJ Z
Chairperson's employer (required): Itt � ��'�
Chairperson's occupation (required): 'S�� i �J��� � U %��
Treasurer's Information: Treasurer's name (required): �-I �T �/.r✓� �-�'' 2'i�j �`�z�sf`1 I
Treasurer's physical address (required): / ls� j _3 �' ; � - �J�J� �
Treasurer's mailing address (if different): �� i�
Bank or Financial Institution:
(do not list acct numbers)
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Treasurer's email address (required): / "�!�'}r�
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Treasurer's phone number (required): �� 7Y l� ZY i9 �
Treasurer's employer (required): <`.� 't'
Treasurer's occupation (required): ��� � _��� '�
Bank name (required): G l�(�/��/1 i � �, �e����
Additional bank name (if applicable): �
Additional bank name (if applicable): �
DECLARATION AND SIGNATURES:
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�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 applicab�e; (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 t ccept all notifications and legal service of process for campaign finance purposes via the email
address(es) provided herein.
Chairperson's signature: � � Date: V /� /� �")
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Treasurer's signature: /,, � .��Y �ih� )!�`"1/ Date: (�/ /� �)
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Candidate's signature (if applicable): ��� ��'L I�JY`� Date: �// / i�i
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Arizona Secretary of State Revision 11/5/16