HomeMy WebLinkAboutCC2021-02 - Smith - Statement of Organization� Inilial Applicatian STATE OF ARIZONA COMMI'iiE� I� NUbABER
O Amended APPtication COMMITTEE STATEMENT (o�ce use on�y)
oate: OF ORGANiZATI�N �'� ��-I — O L
. .
COMMIITE£ TYPE (choose one):
� Candidate 1 0- 0 7-2 1 A' i�? 0 I��I
Commlttee Name (required): Q. f e �s.t A-.�
(firsl or last name & offlce) �
Candidafe lnlonnatJon: Candidale's Name (required): C l!'Yl l�i�[�.--•
Candidale's mailing address (required): S +� e�/�� � r �
Candidale's emai! address {required): '�"�.e� �lir"'�
Cancfidale's phone number (required):
Cand9date's websile {if any): .
O�ce Sought (choose one); 0 County Office: ODis G(if applicable):
[3CitylTown Office: , Y `� d �
0 Scfiaoi Baard Office: �
� 5pecial District Board:
Elecfion CyGe lor Office 5ought (year lhs elecUon wiA lake place) (requfred):
flDistricl (if applip6le)
p District (if applicahle):
GDislrict (if applicable):
� Parry Aff+liatian: � Democrat � Green CI �.iberladan 0 Republican � Other.
\ (required for partisan offices)
�
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O Political Actton Committee (PAC)
Committee Name (required):
(i{ sponsored, musl include
sportso�s name)
Politica! Fu�ctian (oplianal): I] Contributions ❑ Candidate-Relaled Independent Ex�enditures
(select any ihal apply) ❑ Ballol Measure Expenditures � Recall E�endilures
Sportsorship lnformalion:
(if applicable�
Sponsor's name or nickname (required):
Sponsar's mailing address (required}:
Sponsors emaii address {requiredj:
Sponsor s phone number (if any):
Spansor's website (iF any):
Speaa! Stalus
` (iF applicable)
�
� � Polttical Party
CommJltae Name {required):
(musl include party artfiliation)
❑ 5eparale Segregated Fund af a Carporatlon, LLC, �arinership, or Union
Q 5tanding Committee (musl also complele separate standing committee registralion)
❑ Mega PAC (must provide proaf af Mega PAC stalus to filing offioer) (amended applications only}
JurisdiclFon: O Slale Party (must include proo( af quatification pursuant ta A.R.B. § 16-801 pr § 16-8D4)
Q Gounty Party (must include proof of qualificailon pursuant 1D A.R.S. § 1$-802 or § 1fr804j
� Legislalive Distrid Parly (musl inGude proof of organizalion pursuant to A.R,S. § 16-823)
0 City or Tawn Party (musl inGude proaf af qua[iFication p�rsuanl ta A.R.S § 16-802 or � 16-804)
5pecial5tatus � Standing Cvmmittes (musl alsa complele separate sianding cammitlee regisiration)
\ (if applicabta)
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Arizpna Secratary af State Revision 7128l2021
�•O Initlal Appficalion STATE OF ARIZONA COMMITTEE 10 NUMBER
�Amended Applicalian COMMITTEE STATEMENT {oe'ice use an�y)
oate: OF ORGANIZAT�ON _CC�� l`D'� .
. . -
COMMITTEE INFQRMATIQN:
Co�tacf lnformation:
Committee's mailing address (required): i�^"^-�-�
Cammittee's email address (required): .!
Committee's phvne number (if any}: 1
Committee's websile (if any): �
• Chairpersor�'s lnfomtafion: Chairperson's name (required):
1 1-1 �-2 1 PO4 : 14
�
. �reasuror's lnformation,
L�nraq L-u 11
Chairperson's physical address (reguired): �
Chairperson's mailing address (i( diHerent�: f
Chairpersan's email address (reauiredj: �
Chairperson's phane number (required): �
lG'�iairperson's employer (required): I�.,� /����.r—
Chairpersan's occupalian (required): �74,►�
_ �
Treasurer's name {required):
Treasure�s physical address (required}: �7i� s~� %f i rs►,.���L���,�
r 5� �r � v� r �� n h FW � Z Treasurer's malling address (i[ diRerenlj: �
i i U( f 3 23 9� lv�c • ru c� treasure�s emat� address (required): ,
�{QD -�e $ �o -/ Y 80 Treasurers phone number (requlred): _ _
'j'�'�p uN�AfryS i1NLC --
��R� � r„�� Treasurer's employer (required):
Treasurers occupation (tequiredj:
r. �
Bank or Flnancial lrtstltutron: Bank name (required): i% M i�
{do nol lisl acct numhers) Additional bank nama (if applipble):
Additional bank name (if applicable);
DECLARA7lON RND 51G�lATURES:
' I deGare under penalty ot perjury lhat lhe foregoing inFortnation is lrue and correcl. I fur{her decfare that !: (1 } consent lo serve as
chairperson ar lreasurer oF lhe wmmittea named itiereln, if applicahle; (2) designale lhe above-named wmmitlee as my ofiidal candidata
committee and authorize it to receivelmake cantribulianslexpenditures an my behalf, li appficable; (3} har+e read ihe Seuetary af 5tate's
campaign finance and reporting guida; (4) agree la camply with Arizona elaction law, including campaign finance laws cadified at A R.S.
§§ 16-9a1 l0 16-938; and (5) agree L acce a!I notiScaEions a[�d !e I sarvice of pracess for campaig fin ce purposes via the email
address(es) provided herein.
Chairperson's signature� flate: " Q � Z/
�
� \ .
r �� �i��� z�
Treasurer's s(gnalure: �► %�
f '
, Candidale's signalure (if applicable): . I �_ Date� �� z�
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Arizona 5ecretary ot State 32evision 7/29/2021