HomeMy WebLinkAboutStatement of OrganizationCITY � T�WN �� � Ci�.� ��� I+� ��,1�5 � r t�� z c� ri
PnL[TICAL C�MMiTTEE
STATEMFNT �
Titles ifi & �9 Arizana Revrsed 5tatutes
Delrrritions, siatu[ory relereRces and importan[ infarrnat►ar� ❑�� reverse.
�Initial Registratian ❑ Out of 51ate CornRiittee
NAME QF P�LITICAL C�MMI�T[E
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�L�.VrJi] �i��wk r I[�wr-� `c:j�7vL1{
Ab�RESS (iVUMR�R & STREETI /%O�p �'� I W Ci u rd �� �� ll U
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MAILIhG At]aR�55 [i! dilferent frdn a6ove}
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57A7E ZIP
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SiATE TIP
CDhiMlt-E� �-MAIL Ap(7AESS
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D�ES THE POLITICA� CaP�MITTEE HAVE A 5P�N5aRING C7RGAN17ATI�N? 0 YES � NO
If yas, p!ease provide the IoUowing inlarmaUon:
1VAM� O� 5PON50RING ORGAtVIZA���N TYi'E �F QRGANI7.ATI�N
R�pRESS flF SPD�lSqRIR1G aRGAN17Jl�'I��
RFLATfC}NSHIg 70 F'QLiTICAL ���MMITTEE
TYPE OF POk.ITICAf. COMMITTEE - Please checic ❑nly vne �ox:
� CA�[31G�iTE'S Cr'�`:;PAIGyi vC}I.1:'ITTFF ❑ CdhlhllTTEE. QRGA�':lr -� FC}R TH� PLIRPQSE �F �1AKI{VG
IiVC3EPEN�ENT EXPE��717URE5
❑ SEPARA7� SEGRECAT�Q FUNp �STFIE3LI5H�Q RY A CURPQRATIDN
QR LABflR aRGANIZATIa�J ❑ CDINMlTTEE QRGA�11"r: -� IN SIJPPbRi' OF �R OPRaSITIQN
TD ONE OR Evf�RE CA`lal�ll��5
❑ COMMITT[E EN SUPPDR� fl� UR OPPOSlTIQN Ta �HE
QIJALIFICIITIOAf, PA55AGE QFi DEFEAi OF A EiALLO'i' MEASLJRE ❑ POL]TICAI. f]RGAN1CAi IQN (ser, A.R.S. § i6-823j
Pc�<<ion 5�rial Nu�n6vr
5upport 0 U��pose ❑
� CQMMlTT�E ORGANiZ�� TO CIRGULATE OR QPP05E A RECALL
PETITIO�J pR 70 iNFWENCE THE RESULT aF A RECALL ELECTION
❑ Pt7LITiCAL PAFiTY soa A.R.S. §§ 16-$Oi, 16-8d�, 15-SP1 and �6-8�5y
0 EXPL�RAiCfRY COMF�1 TTEE
❑ OTWER TYP� aF CQM141TTEE {please describe}
❑ CH£CK HER� 1F R£GiSTER�C1 WITH THE SEC�iE�fA�iY OF STATE AS A STRHaIlUG P��ITlCAL C�MMIiIE� FURSUANT Ta A.R.S. § 15-9q2.01.
[You must provide a copy o1 ihe slalemant of arganitalion filod with the 5ecretary oi 5tale dasignatir�g s[anding �:ammi�tea slalusj
EACH POLITICAL Ca}:9PdITTEE SHALL HAV� A CHAIRN4AN ANa TREASLJRFR. THE POSiTi0�1 OF CHAIRMA`1 ANa TREASURER �F A 51NGtE
PaLITICAI. CDIVIMITTEE MAY NOT BE HELd BY 7HE SAME INDIVIpUAL, �7(CEPT THAT A GANOIC�ATE tJIAY £3E CHAIRMAiV AMp TREASi1RER flF
H15 OR WER OWN CAMPAIGN CQMWfITT��. A.R.S. §tfi-902(A].
tvAhiE dF Car.it�i� TEE CHAIFtMAN
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CHAIRMAN'S A�QRE55
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CHA�RMAN'S �CCUPATIpN
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NAME OF Cd�v1 ITT�� TR�AS REf�
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7REASURER'S ApDR�S
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FREASIJRER'S DCCl4PATlON
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CHAIRMAN'S �fELEPH��[E �
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CIiAERMAN'S Eh7PL�YER
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T�iE SUR�R'S TELEPHONE i!
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CITY
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TRFASURER'S ��.7PL�YER
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CHAIRIIIAN'S FA?C #
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STATE ZI P
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CHAIRPAFIN'S E•MAIL AODRESS
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TF�FA�IJRER'S FAX li
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STATE Z1 P
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TR�ASURER'S E-h�AIL AQQRES
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6EFO�iE A FOLlTICA� CpP,�Ml�T�E ACCEP7S A CQNTRIBUTI�N �R MAK�S AN EXPEIV❑ITURE 1T SHALL i]E5IGNATE AT LEAST QNE ACCDUNT
AT A OUALIFIED FINANClAL lN571iL1TI�N [ A.{�.S. § 16•902�C)]. LIST THE NAM�S OF AL.L FIiVRtdCIRL INSTiTL1TiQNS WITN WHICH THE
CaMMIl�EE MAiNTAiNS A�C�UNTS QR SAF�TY a�POSli C3QXES. (Do noi lisi account nurnher,.J
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��R AN EXPLDRAT�RY CON�MI�i�E �R A CANpIDATE'S CAMPAIGN CDh��IIT7E�, PR�VI�E THE FOLLaWING INFORMATE�N:
{Dffice sought is optiona! Ior an �xploratpry Committee,}
NAME OF OESIGfJATlNG If�DIV1QUAL {pI} OR CAiJ�I�A7E
� t N N i j �' .41�UW �J
OFFiCE S�UGI-i7
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❑l's�R CAN[]IDA�� �01]RESS
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_� ��u�[ -L'_ t�� n1AI��, �rUc,_J N1V 4L U YE�M�ILAODRE55
Gl fY STATE ZIP
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CANdIaATE'S {or a�51GNAiING INflIVI�UAL'S} STA�Eh9ENT: I au�harix+� Ihe ak�ove-named palitical cammitlr�c3 as my political cammittee to r�caive
contrik�u�iQris and make exp��tidi[uras on my bol�alf.
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Qate: �� � I� Candidate's or Clll's si nalure: Y M IVLI .�II _� � �' �•C'Y�.C/+'L1
9
CHAlRMAiV'S AND 7REASURER'S STATEMENT: We. Ihe undersigned, pursuant lo A.R.S. § i5-9f}2.fl1(66} have read all ihe applicable laws relating tv
campaign C�nance and reporting and lia�e examined lhe infnrmatian contained in his st temenl oi ani a iari ar , to the 6c t of our kna�vEedg� and helie},
it is true, forrecl an� oamploie, ' 4 ��
❑ata: ' �� �f Chairman's siynalure: � �� � ��� � _''''�- '`� �
�
�r� � � ��
Qate: �� �� Treasurer's signature: � �
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�EFINITIflN OF P�LI1'ICAL COMMI1TEE: A.R.S. § 1&-901(1sj "Polilic��i commiltae" means a candiclate ar any associa[ion ar caiT�binatknrt ❑f parsons ll�at is
organir�d, condizcled ar comhined far tha purpase ❑f irzfluen�ing lhe r�sul! vi any olection or t❑ determine whe�her an ind�vidua! wiH 4�eeome a candidale far
�lect�on in Shis stale ar in any caunty, city, tovrn, distriet or precmc� in this slate, tha� erigages in politiral acti�ity irti �half of vr agains[ a candida[e lar elec�ian or
retentinn or in support ni or apposition �a an i�liliativa, referendum or recall or a�iy ather measure or pro�3osilion and thal applies f�r a serial number anci circulates
pelitinns and, in lhe case af a candic�ale for nu6lic office except lhQse exeinpl pvrsuanl to section 16-903, lhal rer.eives canlribulians or makos expQnditures in
connection tharewilh, natwithstanding lhat if�e � ssociativn or combinalia�3 0l persans may ba a part ot a larger association, cam�ination di parsons or sponsvring
arganizalian no[ primarily otganized, conductnd ❑r comhined for the purpcse ❑f influaneing ihe resulE of any elacEian in this state or in any caunty. cily, tvwn or
precinc� in fhis sta[e. Ex�rnples ot typas af polilical commiitees ara listad on the fran[ af lhls #orm.
NOTE FOR flVf}IVIaUALS INV�LV�D IN A�LITICAL ACTiVITIE5: An i�dividual a�fing alonr:, Unless lt�at indivi�ival is a candidatQ, is nai a palitical c�mmiliee
under Anzona fa�v and ��eed nvt file a sla�erncnl of ❑rganization. If any addiliQnal person or �ersans jain the elfo�t (as defined a6ove in A.R,S. § 1fi•901R�3yj
he•�un !�y an individual, lYia associatian oi persons has hecome a"pokiti�al commilsae" under Ariaana law, and mi�st registor the cornmittee pursuant to A.R.S. §
15•90?.fl t [A].
NaTE FqR SH05E INVOLVED lN INITiA71VE, R�F�REHDUM AN� R�CALL EFFfl�iTS: BQfore circulaling iniliative, rof4rondum or recall patitians, a pvlilical
commitlee musl iile its staEPmenE ai organi7�tion wilh the appr❑�r�ate filing flfficc. Signatures ❑htained Qrr ��etiliQns prior to tha fili�g n} the slal�ment ol
❑rganizalifln ara vQid ard st�all not �.+o �ountod in determining Ilie Ic+g�i sutfi�ienc;+ 01 the pelition. A.R.5. §§ ] 9-1 t4�B} and 39-�02[C}. Even thaugh an individuaV,
aciing aEone, may begir� �}�e initiativa, referandum ar rQ�all ef#art, as soon as othar persons jain lhe alfo�t, ihe associali4n af persnns must regis3er as a paliti�al
cemmitlee.