HomeMy WebLinkAboutPC2018-08 - Magazine for Council - Amended Statment of Organization� Initial Application
�Amended Application
Date:
•
COMMITTEE TYPE (choose one):
0�—L1-18P03:53 RCVD
STATE OF ARIZONA COMMITTEE ID NUMBER
COMMITTEE STATEMENT (otece use on�y)
� OF ORGANIZATION � v � �' " � �
� f
/�i%l�l�-� id�i� f'-�0� l�D(111�(..i �
Candidate Information: Candidate's Name (required): A���V 14 . l'% �(g"� 2/ t�/ �
Candidate's mailing address (required): /.�� `y"7 -f C . �� f0U ��U� l.�G /�����
�� ��p ��'�.�i�bJ��.�9'1�f4}l, ��
Candidate's email address (required): /�JLttN o �
Candidate's phone number (required): �O() —� D`f '" "T lo b l
Candidate's website (if any):
O�ce Sought (choose one): 0 Govemor � Secretary of State � Attorney General 0 State Treasurer
� Superintendent of Public Instruction 0 State Mine Inspector 0 Corporation Commissioner
m Candidate
Committee Name (required):
(first or last name & office)
0 State Senate
� County Office:
@f City/Town Office:
0 State House of Representatives � District (required):
� District (if applicable):
�.c���..1�, l l _
Election Cycle for Office Sought (year the election will take place) (required):
PartyAffiliation: B Democrat � Green 0 Libertarian
(required for partisan offices)
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-.. . _....._. .---. ._ .. __ ..................__..................,.,......,,.,.,.,,,,,,,,.,,,, , ._.
0 District (if applicable):
�0) �
� Republican p Other:
. ..__..__...._. .......................... .. ... . .., . ,, ...
� Political Action Committee (PAC)
Committee Name (required):
(if sponsored, must include
sponsor's name)
Politica/ Function (optional): ❑ Contributions ❑ Candidate-Related Independent Expenditures
(select any that apply) ❑ Ballot Measure Expenditures ❑ Recall Expenditures
Sponsorship Information:
(if applicable)
Sponsor's name or nickname (required):
Sponsor's mailing address (required):
Sponsor's email address (required):
Sponsor's phone number ('rf any):
Sponsor's website (if any):
�
Special Status ❑ Separate Segregated Fund of a Corporation, LLC, Partnership, or Union
�(if applicable) ❑ Standing Committee (must also complete separate standing committee registration)
❑ Mega PAC (must provide proof of Mega PAC status to filing officer) (amended applications only)
/ ...., ,
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0 Political Party
Committee Name (required):
(must include party affiliation)
Jurisdiction:
Specia/ Status
(if applicable)
0 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)
0 Standing Committee (must also complete separate standing committee registration)
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Arizona Secretary of State Revision 11/5/16
0 Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER
� Amended Application - COMMITTEE STATEMENT (office uspe only)
�ate: OF ORGANIZATION �� ���b �� �
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COMMITTEE INFORMATION:
Contact Information: Committee's mailing address (required): f U� T� �J •��1 ��+`' ��� � T v�
Committee's email address (required): � u L�l�ii � V- j'�i 1� )�. �� M
Committee's phone number (if any): ��i U� b O�— `7 b� b
Chairperson's Information
Treasurer's Information:
Bank or Financial Institutic�n:
(do not list acct numbers)
DECLARATION AND SIGNATURES:
Committee's website (if any):
f� i
Chairperson's name (required): �,�i��%1 I� r � �% �' �� i h��
Chairperson's physical address (required): � 5 � ���
Chairperson's mailing address (if different):
Chairperson's email address (required): /-�h S iQ-����
Chairperson's phone number (required): l { �� — ��-- `t"�o � l�
Chairperson's employer (required): Iv J�
Chairperson's occupation (required): dC G_-`�Ci���
Treasurer's name (required): �r� �1� �) S � �
Treasurer's physical address (required): I o� Oo� g� 4� .� i� ���'}' �� I�i '�_
�
Treasurer's mailing address (if different): %} l''� �
Treasurer's email address (required): ��=�a��� R @ .Nt'� � + i:i1. �
Treasurer's phone number (required): [ � t � � � � ^ / "7 � c1
Treasurer's employer (required): Al l �
Treasurer's occupation (required): ��'f � Y� ��
Bank name (required): � Iti��E�
. ,
Additional bank name (if applicable):
Additional bank name (if applicable):
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 o�cial candidate
committee and authorize i: 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 here in. � `� r
.f �/ / 1 G
I Chairperson's signature: �� Date: /� � I/ t�
v %�f�
Treasurer's signature: Date: � �l �CJ
�� � �
Candidate's signature (if applicable): G/,�/"� �� Date: �
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Arizona Secretary of State Revision 11/5/16