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HomeMy WebLinkAboutBohen 4 OV - Statement of Organization - 2/20/2024A Initial Application Ame`nzd i ppI lion Date: q COMMITTEE TYPE (choose one): Candidate Committee Name (required): (first or last name & office) Candidate Information: Once Sought (choose one): STATE OF ARIZONA COMMITTEE STATEMENT OF ORGANIZATION Candidate's Name (require Candidate's mailing addres Candidate's email address 13DIstrict (it applicable): F-ity/Town Office: ej W yt (_.e U a'r ) CIDistrict (if applicable): © School Board Office: 13 District (if applicable): El Special District Board: 13 District (if applicable): Candidate's phone number Candidate's website (if any M County Office: Election Cycle for Office Sought (year the election will take place) (required): Party Affiliation: 10 Democrat 13 Green 10 Libertarian 13 Republican 13 Other: (required for partisan offices) M 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) Sponsor's name or nickname (required): Sponsor's mailing address (required): _ Sponsors email address (required): _ Sponsor's phone number (if any): _ Sponsor's website (if any): FEB 20120m 11,2E TOV COMMITTEE ID NUMBER (office use only) ov-rL a0-05 ❑ 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) (must include party affiliation) Jurisdiction: E3 State Party (must include proof of qualification pursuant to A.R.S. § 16-801 or § 16-804) 13 County Party (must include proof of qualification pursuant to A.R.S. § 16-802 or § 16-804) C Legislative District Party (must include proof of organization pursuant to AR.S. § 16-823) 17 City or Town Party (must include proof of qualification pursuant to A.R.S. § 16-802 or § 16-804) Special Status O Standing Committee (must also complete separate standing committee registration) (if applicable) 0 Arizona Secretary of State Revision 7/29/2021 F 3 20 L t n,,.; „ TOV © Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER B Amended Application �`�'� COMMITTEE STATEMENT (office use only) Date: OF ORGANIZATION 0VT(_ ao-o5 COMMITTEE INFORMATION: Contact Information: Committee's mailing address (required): 2ZZ-(P- 3 w V i f 5 0 C Jo V A I ID^/ Committee's email address (required): rJD I L(/� U 1 �. G J"I a �� 1 - C.c Vhn Committee's phone number (if any): _ 3(to) Committee's website (if any): O G o Chairperson's Information: Chairperson's name (required): e--1 I VLIs3oiieel r� Chairperson's physical address (required): V / f to TI Chairperson's mailing address (if different): t rn Chairperson's email address (required): F�.� 1\4.� �- „ - t Ginn a . GG ✓fir Chairperson's phone number (required): Chairperson's employer (required): Chairperson's occupation (required): r r �P Pf Treasurer's Information: Treasurer's name (required): Treasurer's physical address (required): 22" t r er -f1,2AZ Treasurer's mailing address (if different): Treasurer's email address (required): );�tO V1 o/1 PA Treasurer's phone number (required): (D Treasurer's employer (required): Treasurer's occupation (required): Bank or Financial Institution: Bank name (required): _/1 At, (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 coned. 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 receivetmake contributions/expenditures on my behalf, if applicable; (3) have read the Secretary of State's campaign finance and reporting guide; (4) agree to comply Wth 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 email address(es) provided herein. Chairperson's signatur Treasurer's signature: Candidate's signature e: Date: Date: (if applicable): Date: , % t7- U . ,1r. Arizona Secretary of State Revision 7/29/2021