HomeMy WebLinkAboutCommittee to Elect Melanie Barrett - Statement of Organization - 4/15/2022 �..�4". T!""���,'"' tw� !�`: '�i C�
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O Initial Appiication �r STATE OF ARIZ�NA COMMiTTEE ID NUMBER
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1�.Amended Application * -a�,�� CQMMITTEE STATEMENT
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COMMiTTEE TYPE(choose one):
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Committee Name re uired: �t �- l_--,�- � `��Q�� ����C�
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(first or last name 8 office)
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Candidate Information: Candidate's Name(required): ��IC�Y�I� �r Y� T
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° Candidate's mailing address(required): �3-1�.��� �1 t v C.a�I,� P�. ,
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Candidate's email address(required): �C r�� '►C �
; Candidate's phone number(required): � �3 3" 2
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� Candidate's website(if any): � r
O�ce Soughr(choose one): Ll County Office: ODistrict (if applicable.
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; �+tylTown Office: Cpu�L(�������"` t7District(if applicable).
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❑School Board Office: p District(if applicable):
� O Special District Board: ❑District(if appiicable):
; Elecrion Cycle for Office Sought(year the election will take place)(requiredj:
Party Affiliation: ❑Democrat ❑Green ❑Libertarian O Republican L7 Other:
��� (required#or partisan offices)
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0 Poliiical Action Committee(PAC)
Commiftee Name�required):
(if sponsored,must include
sponsor's name)
Polrtical Function(optional)� �Contributions C]Candidate-Related Independent Expenditures
{select any that apply) Cl Ballot Measure Expenditures D Recall Expenditures
Sponsorship Informafion: Sponsor's name or nickname(required��
(if applicable) Sponsor's mailing address(requiredj:
Sponsor's email address(required):
Sponsor's phone number(if a�y):
Sponsor's website(if any):
Specia!Sratus C�Separate Segregated Fund of a Corporation,LLC,Partnership,or Union
(if applicable) O Standing Committee(must also complete separate standing committee regisiration)
O Mega PAC(must provide proof of Mega PAC status to fifing officer)(amended appfications only)
� Political Party
Commitiee Name(required):
(must include party affiliation)
Jurisdiction: O State Party(must inctude proof of qualification pursuant to A.R.S.§16-801 0�§1fi-804�
C�County Party(must include proof of qualification pursuant to A.R.S.§16-802 or§1fi-804)
[�Legislative District Pa�ty(must include proof of organization pursuant to A.R.S.§16-823j
t�City or Town Party(must include proof of qualification pursuant to A.R.S.§16-802 or§16-804)
SpeciaJ Siatus �Standing Committee(must also complete separate standing committee regisiration)
(if applicable)
Arizona Secretary of State Revision 7/29/2021
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O initial Apptication STATE OF ARIZ4NA COMM{TTEE ID NUMBER
�Amended Application ��� CO M M ITTE E STAT E M E N T to�ce use on�y)
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oate: �-��-- OF ORGANiZATION
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COMMiTTEE INFORMATION:
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n c t l n f o r m a t i o n: C o m m i tt e e's m a i{i n a d d r e s s(r e q u i r e d): � `� ,`� ��U'e� ��� O
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Committee's email address re uired : �n, ��" YO t a�' 'CD
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Committee's phone number(if any): 5� ��3 '
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Committee's website{if a�y): � � � �r
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Chairperson's lnformation� Chairperson's name(required): �� t�.`Q��Q,_, ���
Chairperson's physicai address{required): �3'1�i� ► S I �U�.�( l���,A� ��•
Chairperson's mailing address(if different):
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Chairperson s ema�l address(requ�red) � �
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Chairperson's phone number(required): 2-� 333'� 7�2�J
Chairperson's employer(required) Y1 � l./r� �
Chairperson's occupation(required):�C�L��`„�1 �Q��Q-�'
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Treasurer's Informa�ion: Treasurer's name(required}: � _���Y1�Q. �Y r Q�1"
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Treasu�er s physical address(required�: 1���� �►�1,U e.Y ��lS��Q ���
Treasurer's mailing address(if different):
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Treasurer's email address(required): m a ��b � Q
Treasurer's phone number(required) ��� 3 3 3`7�7_7
Treasurer's employer(required): 11JC1 � Q Y 4 v(��1
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Treasurer's occupation(required): �l �
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Bank or Financia!Institution: Banfc name(required). Q
(do not list acct numbers) Additional bank name(if applicable)�
Additional bank name(if applicable):
DECLARATION AND SIGNATURES:
1 declare under penalty of perjury that the toregoing 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)desig�ate the above-named committee as my official candidate
committee and authorize it to receivelmake 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 iarvs codifed at A.R.S.
§§16-901 to 16-938;and(5)agree to accept a!I notifications and legal service of process for campaign finance purposes via the email
address(es)provided herein.
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' �, Dale: �1 � I�"��2--
Chairperson s signature.
.
Treasurer's signature: Date� �' �5 �2 z
.
Candidate's signature(if applicable): Date: _)� ��� Z�
Arizona Secretary of State Revision 7/29I2021