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HomeMy WebLinkAboutThe Committee to Elect Harry "Mo" Greene M.D. - Statement of Organization - 12/11/2023d Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER 0 Amended Application COMMITTEE STATEMENT (office use only) Date: ���„'; ' OF ORGANIZATION oV T6 �3 -0.2 r COMMITTEE TYPE (choose one): 0 Candidate Committee Name (required): Jdr� ,�,•rcrZ�c tc_j yj j[^C (first or last name & office) Candidate Information: Candidate's Name (required): ,a0.cLRy [_a_gcaE n- Candidate's mailing address (required): tL13Cj - ._Lc j . K? `,;� Candidate's email address (required): n(�L n(L r-awx; :l ,c ntlr1 Candidate's phone number (required): �- 2 c: 5`uy • 13-� a Candidate's website (if any): Office Sought (choose one): 0 County Office: Mistrict (if applicable): City/Town Office: t �, h,%, `1 Cal", ODistrict (if applicable): 0 School Board Office: 0 District (if applicable): 0 Special District Board: ODistrict (if applicable): Election Cycle for Office Sought (year the election will take place) (required): ,_, ; �A, Party Affiliation: 0 Democrat 0 Green 0 Libertarian © Republican 0 Other: N pAiQ•! ►Sc�O�J (required for partisan offices) 0 Political Action Committee (PAC) Committee Name (required): (if sponsored, must include sponsor's name) Political Function (optional): ❑ Contributions ❑ Candidate -Related Independent Expenditures (select any that apply) ❑ Ballot Measure Expenditures ❑ Recall Expenditures Sponsorship Information (if applicable) Special Status (if applicable) 0 Political Party Committee Name (required): (must include party affiliation) 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): ❑ Separate Segregated Fund of a Corporation, LLC, Partnership, or Union ❑ Standing Committee (must also complete separate standing committee registration) ❑ Mega PAC (must provide proof of Mega PAC status to filing officer) (amended applications only) Jurisdiction: 0 State Party (must include proof of qualification pursuant to A.R.S. § 16-801 or § 16-804) 0 County Party (must include proof of qualification pursuant to A.R.S. § 16-802 or § 16-804) t] Legislative District Party (must include proof of organization pursuant to A.R.S. § 16-823) 0 City or Town Party (must include proof of qualification pursuant to A.R.S. § 16-802 or § 16-804) Special Status El Standing Committee (must also complete separate standing committee registration) (if applicable) Arizona Secretary of State Revision 7/29/2021 Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER 13 Amended Application �� - COMMITTEE STATEMENT (office use only) Date: OF ORGANIZATION U ��r c a3 " �a COMMITTEE INFORMATION: Contact Information: Committee's mailing address (required): lbj,,u:i s� , G D . �,,.�� 2a ihcz 4a,1 AAl" Committee's email address (required): -Ae-, r "r r=r,Q c ,i n,c •A A t g54 n Committee's phone number (if any): Committee's website (if any): Chairperson's Information: Chairperson's name (required): G e. o (Z4 Chairperson's physical address (required): C_tig(Z► k0— .0CGtr� i � tL) Chairperson's mailing address (if different): c' e-- Chairperson's email address (required): [t�.(,��. t �% Q i= GG�L, Chairperson's phone number (required): _ 1-1,L` j 4 c� 01-4 Chairperson's employer (required): Chairperson's occupation (required): �l'z I I V-11D Treasurer's Information: Treasurer's name (required): r--" s , f5 ,.,-r 9 Treasurer's physical address (required): Wig; tine O,FG r"N, � 1 ,, Fes{ Al A Treasurer's mailing address (if different): [' Treasurer's email address (required): C af,� ,�1e&A7 -7 Treasurer's phone number (required): Sj 2,t> Aei'A • t t,y'r5 Treasurer's employer (required): Ack, rQA Treasurer's occupation (required): fte_k:ctl_( Bank or Financial Institution: Bank name (required): -R� ,.,� KM a r I C a (do not list acct numbers) Additional bank name (if applicable): Additional bank name (if applicable): 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 official 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; ( 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 ' t all notif tions an egal service of process for campaign finance purposes via the email address(es) provided herein. 'j Chairperson's signature: X Date: 14111 1ZL Zk' Treasurer's signature: Date: 2 z Candidate's signature if a lica le :e�� 9 (� pp ) CC Date: Arizona Secretary of State Revision 7/29/2021