HomeMy WebLinkAboutPC2018-08 - Magazine for Council - Statement of OrganizationInitialApplication
D Amended ApplicationDate:UjjZ ljg
COMMITTEETYPE (choose one):
D Candidate
Committee Name (required):
(first or last name &office)
Candidate Information:
STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
06-12-18P03
COMMITTEE ID NUMBER
(office use only)
RCVD
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Candidate's Name (required):f\LA (J (4.0^f^Q-ft^l <^f&
Candidate's mailing address (required):/b^ti^&1l>ft)ftj P?&1bO{£flc^B
Candidate's email address (required):f)lA™.fafcG-ftZrl *1 &<2.6~M ft IL.td (^
Candidate's phone number (required):^7 <S ""Co An ~H*b W (
Candidate's website (if any):
Office Sought (choose one):•Governor •Secretary of State •Attorney General •State Treasurer
•Superintendent of Public Instruction •State Mine Inspector D Corporation Commissioner
D State Senate
D County Office:.
•State House of Representatives • District (required):
• District (if applicable):
__• District (if applicable):KKCity/Town Office:Oxi (M[C\L
Election Cycle for Office Sought (year the election will take place)(required):
Party Affiliation:D Democrat Q Green •Libertarian
(required for partisan offices)
D Republican •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 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 (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)
D 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)
D County Party (must include proof of qualification pursuant to A.R.S.§16-802 or §16-804)
O 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
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STATE OF ARIZONA COMMITTEE ID NUMBER
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Contact Information: Committee's mailing address (required): /�'7 `T�
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Committee's phone number (if any): � �1/? � � �'�{ — ��d 4� �
Committee's website (if any):
Chairperson's Information: Chairperson's name (required): � ��� � � � �� ��3� % 1 !�li?
Chairperson's physical address (required): / T S �� d�`f l%
Chairperson's mailing address (if different):
Treasurer's Information:
Bank or Financial Instifution:
(do not list acct numbers)
DECLARATION AND SIGNATURES:
Chairperson's email address (required): � �"��� �Vl f-� �7 � �' � �� ��� ��� �— �� �7
Chairperson's phone number (required): y�� "'L D�I —`1" iD 6�
Chairperson's employer (required): N'�
Chairperson's occupation (required): �� � ��� E�
Treasurer's name (required): �,%� �1 � �� � tvi ��'d�'Z � ��
Treasurer's physical address (required): / � -T �' � �'% � ��J� ��� �� /T U ii
Treasurer's mailing address (if different):
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Treasurer's email address (required): �� ���1%5�� �� �� � L'W �
Treasurer's phone number (required): �� �� -• (� � °T — � V� � k�
Treasurer's employer (required): �1 �
Treasurer's occupation (required): i"� 1�G 1)�. ��
Bank name (required): 1.--�rs7 ��
Additional bank name (if applicable):
Additional bank name (if applicable):
�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 acc t all notifications and legal service of process for campaign finance purposes via the email
address(es) provided herein.
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Chair erson's si nature: �a�/�4 �' �� ��� Date:
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Treasurer's signature: L��/�71�-lt�'7'✓ �� �.� � Date: G����1�
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\ Candidate's signature (if applicable): Date: /
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Arizona Secretary of State Revision 11/5/16