HomeMy WebLinkAboutPC 2018-07 - Sharron Grzybowski - Statement of Organizationpj Initial Application
Ej Amended Application
Date:
COMMITTEE TYPE (choose one):
k Candidate
STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
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COMMITTEE ID NUMBER
(office use only)
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Candidate's Name (required):jS^Q ft<T^T^Cr-Cg/'AW)\i~)S -n >'
Candidate's mailing address (required):/£&jJEaJ&/.:7P)|fa^<£-""^V ^//C?5>2r^<g>
Candidate's email address (required):<5Hlc\f CCY^><C|f 1~zi:$£}{(fc},£?rr)tSU\Amo
Candidate's phone number (required):JpQra^/•yj 6 2~^]Uf C3
Candidate's website (ifany):
Committee Name (required):
(first or last name &office)
Candidate Information:
OfficeSought (choose one): •Governor D Secretary of State
•Superintendent of Public Instruction
•Attorney General
•State Mine Inspector
•State Treasurer
•Corporation Commissioner
•State Senate •State House of Representatives • District (required):
•County Office:• District (if applicable):
'Q City/Town Office:"T5/xSX^[j2Jr0j I • District (if applicable):
Election Cycle for Office Sought (year the election willtake place)(required):
Party Affiliation:D Democrat •Green •Libertarian
(required for partisan offices)
•Republican D Other:
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 •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 (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)
D 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)
D Standing Committee (must also complete separate standing committee registration)
Arizona Secretary of State Revision 11/5/16
� Initial Application
0 Amended Application
Date:
COMMITTEE INFORMATION:
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STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
COMMITTEE ID NUMBER
(office use only)
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Contact Information:
Committee's mailing address (required): � �t1) Q � � �l� Gf�y'lw �(11YTiY��✓t,�<, � ��
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Chair erson's Information: Chair erson's name re uired : -i -� L� �" ��Y
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Treasurer's lnformation:
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Treasurer's email address (required): t�SS �}-yy�L / � ,�/� �t �} �(• /'l�'�
Treasurer's phone number (required): "y t6'�JL7 � �'7"]' � 5 L�' ��j
Treasurer's employer (required): ('�'i7 rCC`�
Chairperson's physical address (required): � (,9 � � �; �"- �� ,��tz � � a'
Chairperson's mailing address (if different): � .✓f� �
Chairperson's email address (required): �ir.� "1 � G� i� 1�� l���sra,i �
Chairperson's phone number (required): .�I�iS• �y�:'a/ • (,�J (� � c—
Chairperson's employer (required): Q-�- �('A ��
Chairperson's occupation (required): . �YrF-) V:�[�'i�L E:r"Y_�r����'i'`�
Treasurer's name (required): .11�'Y1L I �� �'fi'� e�
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Treasurer's physical address (required): )Ci!� �J l� �. / ��l('�5 �S'
Treasurer's mailing address (if different): �� I
Treasurer's occupation (required):
Bank orFinancial lnsfitution: Bank name (required): �i�hi `��rl��t �F�V(-�= G:--�
(do not list acct numbers) Additional bank name (if applicable): J
Additional bank name (if applicable):
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 al otifications and legal service of process for campaign finance purposes via the email
address(es) provided herein.
Chairperson's signature: --�1� "iJ �ni �b� Date: �I �I I �
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Treasurer's signature: � Date: � r
Candidate's signature (if applicable): '� r �� Date: (i� — �'" ���
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Arizona Secretary of State Revision 11/5/16