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STATEMENT OF ORGANIZATION'
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Titles 16& 19,Arizona Revised Statutes
Definitions,statutory
references and important
information on reverse.
❑ Initial Registration ❑ Out of State Committee la Amended Statement .ID#
01166-9406/
I NAME OF POLITICAL COMMITTEE DATE
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ADDRESS(NUMBER&STREET) CITY STATE ZIP
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MAILING ADDRESS(if different from above) CITY STATE ZIP
COMMITTEE TELEPHONE# COMMITTEE FAX#(if any
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DOES THE POLITICAL COMMITTEE HAVE A SPONSORING ORGANIZATION? ❑ YES TPC NO
If yes,please provide the following information:
NAME OF SPONSORING ORGANIZATION TYPE OF ORGANIZATION
ADDRESS OF SPONSORING ORGANIZATION RELATIONSHIP TO POLITICAL COMMITTEE
TYPE OF POLITICAL COMMITTEE-Please check only one box:
❑ CANDIDATE'S CAMPAIGN COMMITTEE
94 SEPARATE SEGREGATED FUND ESTABLISHED BY A CORPORATION OR LABOR ORGANIZATION
le COMMITTEE IN SUPPORT OF OR OPPOSITION TO THE QUALIFICATION,PASSAGE OR DEFEAT OF A BALLOT ISSUE
❑ COMMITTEE ORGANIZED TO CIRCULATE OR OPPCSE A RECALL PETITION OR TO INFLUENCE THE RESULT
OF A RECALL ELECTION
❑ POLITICAL PARTY(only state or county committees of an organization that meets the requirements for recognition as a political party
—see A.R.S.§§ 16-801, 16-804, 16-821 and 16-825)
❑ COMMITTEE ORGANIZED FOR THE PURPOSE OF MAKING INDEPENDENT EXPENDITURES
❑ COMMITTEE ORGANIZED IN SUPPORT OF OR OPPOSITION TO ONE OR MORE CANDIDATES
❑ POLITICAL ORGANIZATION(an organization that is formally affiliated with and recognized by a political party including a district
committee that is organized pursuant to A.R.S.§16-823)
❑ OTHER TYPE OF COMMITTEE (please describe)
EACH POLITICAL COMMITTEE SHALL HAVE A CHAIRMAN AND TREASURER. THE POSITION OF CHAIRMAN AND TREASURER OF A SINGLE
POLITICAL COMMITTEE MAY NOT BE HELD BY THE SAME INDIVIDUAL, EXCEPT THAT A CANDIDATE MAY BE CHAIRMAN AND TREASURER CF
HIS OWN CAMPAIGN COMMITTEE. A.R.S.§ 16-902(A).
NAME OF COMMITTEE CHAIRMAN CHAIRMAN'S TELEPHONE#
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CHAIRMANIS ADDRESS CITY STATE ZIP
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CHAIRMAN'S OCCUPATION CHAIRMAN'S EMPLOYER
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NAME OF COMMITTEE REASURER TREASURER'S TELEPHONE#
5a-x(y)ti?-4._TREASURER'S ADDRESS CITY STATE ZIP
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TREASURER'S OCCUPATION TREA ER'S EMPLOYER
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EACH POLITICAL COMMITTEE SHALL MAINTAIN AT LEAST ONE ACCOUNT AT A QUALIFIED FINANCIAL INSTITUTION.A.R.S.§ 16-902(C). LIST
THE NAMES OF ALL FINANCIAL INSTITUTIONS WITH WHICH THE COMMITTEE MAINTAINS ACCOUNTS OR SAFETY DEPOSIT BOXES. (Account
numbers do not need to be listed.)
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FOR A CANDIDATE'S CAMPAIGN COMMITTEE,PROVIDE THE FOLLOWING INFORMATION:
NAME OF CANDIDATE PARTY AFFILIATION OFFICE SOUGHT COUNTY OF RESIDENCE.
CANDIDATE'S ADDRESS CITY STATE ZIP
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CANDIDATE'S STATEMENT: I authorize the above-named political committee as my political committee to receive contributions and make expenditures
on my behalf.
Date: Candidate's signature:
CHAIRMAN'S AND TREASURER'S STATEMENT: We, - undersigne• - A- e a ined the fo ation contained in this statement of organization and,
to the best of our knowledge and belief,it is true,correct = • corm'ete.
Date: Chairman's signature: 1 k is
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Date: Treasurer's signature:
DEFINITION OF POLITICAL COMMITTEE: A.R.S.§16-901(15)
"Political committee"means a candidate or any association or combination of persons that is organized,conducted or combined for the purpose of
influencing the result of any election in this state or in any county,city,town,district or precinct in this state,that engages in political activity in behalf of or
against a candidate for election or political activity in behalf of or against a candidate for election or retention or in support of or opposition to an initiative,
referendum or recall or any other measure or proposition and,in the case of a candidate,that receives contributions or makes expenditures of more than
two hundred fifty dollars in connection therewith, notwithstanding that the association or combination of persons may be a part of a larger association,
combination of persons or sponsoring organization not primarily organized,conducted or combined for the purpose of influencing the result of any election
in this state or in any county,city,town or precinct in this state. Examples of types of political committees are listed on the front of this form.
NOTE FOR INDIVIDUALS INVOLVED IN POLITICAL ACTIVITIES:
An individual,acting alone,is not a political committee under Arizona law and need not file a statement of organization. If any additional person or persons
join the effort(as defined above in A.R.S.§16-901(15))begun by an individual,the association of persons has become a"political committee"under
Arizona law,and must file a statement of organization within ten days. A.R.S.§16-902.01(A).
NOTE FOR THOSE INVOLVED IN INITIATIVE,REFERENDUM AND RECALL EFFORTS:
Before circulating initiative,referendum or recall petitions,a political committee must file its statement of organization with the appropriate filing office.
Signatures obtained on petitions prior to the filing of the statement of organization are void and shall not be counted in determining the legal sufficiency of
the petition. A.R.S.§§19-114(B)and 19-202(C). Even though an individual,acting alone,may begin the initiative,referendum or recall effort,as soon as
other persons join the effort,the association of persons must register as a political committee. The statement of organization must be filed regardless of
whether the committee intends to accept contributions or make expenditures.
WHERE TO FILE: A.R.S.§16-916(A)
Secretary of State's Office—political committees supporting or opposing candidates for state offices and members of the legislature,for justices of the
supreme court,for judges of the court of appeals, including recall of any of those officeholders,and for a statewide initiative or referendum or any measure
or proposition appearing on a state general election ballot
County Elections Office—political committees supporting or opposing candidates for county offices,including recall of any of those officeholders,school
district governing board members or ballot questions,judges of the superior court seeking retention,special taxing districts and a county initiative or
referendum of any measure of proposition appearing on a county election ballot
City or Town Clerk's Office—political committees supporting or opposing candidates for city or town offices,including recall of any of those officeholders,
and for a city or town initiative or referendum or any measure or proposition appearing on a city or town election ballot
STATUTORY REFERENCES:
POLITICAL COMMITTEE DEFINITION 16-901(15) OUT OF STATE POLITICAL COMMITTEE 16-902.02
ORGANIZATION OF POUTICAL COMMITTEE 16-902 CANDIDATE'S CAMPAIGN COMMITTEE 16-903
FINANCIAL INSTITUTION REQUIREMENT 16-902 TREASURER'S DUTIES 16-904
REGISTRATION OF POLITICAL COMMITTEE 16-902.01 TERMINATION OF POLITICAL COMMITTEE 16-914
DEADLINE FOR REGISTRATION 16-902.01 INITIATIVE AND REFERENDUM COMMITTEE 19-114
AMENDMENTS TO REGISTRATION 16-902.01 RECALL COMMITTEE 19-202
Revised 1/97