HomeMy WebLinkAboutStatement of Organization - B KalivianakisI Initial Application
I Amended Application
Date:
COMMITTEE TYPE (choose one):
STATE OF ARIZONA
COMMITTEE STATEIVIENT
OF ORGANIZATION
COMMITTEE ID NUMBER
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EI Political Action Committee (PAC)
Committee Name (requ-ired)..
(if sponsored, must includesponsor's name)
Political Function (ophonal)..
(select any that apply)
Sponsorshi p I nformation..
(if applicable)
Special Status
(if applicable)
I Contributions . Candidate-Related Independent Expenditures
I Ballot Measure Expenditures
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):
I Recall Expenditures
H Separate Segregated Fund of a Corporation, LLC, Partnership, or Union
I Standing Committee (must also complete separate standing committee registration)
H Mega PAC (must provide proof of Mega PAC status to filing officer.) (amended applications only)
Arizona Secretary of State Revision 7/29/2021
COMMITTEE ID NUMBER
(office use only)oecsoa5 -c3 Li
DECLARATION AND SIGNATURES:
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 offidal 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 all notifications and legal service of process for campaign finance purposes via the emailaddress(es) provided herein.
Chairperson's signature:
Treasurer's signature:
Candidate's signature (if applicable):E BZZZZI
Date.- a.+ r,`
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Arizona Secretary of State Revision 7/29/2021