HomeMy WebLinkAboutRobb 4 OV Council - Statement of Organization - 3/18/202413 Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER
l Amended Application COMMITTEE STATEMENT (office use only)
Date: 3/rrmy -OF ORGANIZATION OV-r6 aY - 0l
COMMITTEE TYPE (choose one):
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C Candidate
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Committee Name (required):
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(first or last name & office)
Candidate Information:
Candidate's Name (required): —R08'i
Candidate's mailing address (required): Cnoif* LAua-Sa*IR ✓snq, Diaz tik i? az-
Candidate's email address (required): -Rosa y OVlywdcx mg-M.4'e
Candidate's phone number (required): S2O - 9 G - ci Z 3-0
Candidate's vmbsite (if any): 1\ OBS t{ 0 V CO VLA Ci e_ . CD M
Once Sought (choose one):
O County Office: In District (if applicable):
k-J1y/T0wn Office: _rOUirJ 1_.OUIJ C IL ODistrict (tf applicable):
13 School Board Office: 13 District (if applicable):
13 Special District Board: ODisbict (if applicable):
Election Cycle for Once Sought (year the election will take place) (required):
Party Affiliation:
12 Democrat 13 Green O Libertarian 19 Republican C Other:
(required for partisan offices)
O Political Action Committee (PAC)
Committee Name (required):
(if sponsored, must induce
sponsors name)
Political Function (optional):
❑ Contributions ❑ Candidate -Related Independent Expenditures
(select any that apply)
❑ Ballot Measure Expenditures ❑ Recall Expenditures
Sponsorship Information:
Sponsor's name or nickname (required):
(if applicable)
Sponsor's mailing address (required):
Sponsors email address (required):
Sponsors phone number (if any):
Sponsors viebsite (if any):
Special Status
❑ Separate Segregated Fund of a Corporation, LLC, Partnership, or Union
(if applicable)
❑ Standing Committee (must also complete separate standing committee registration)
❑ Mega PAC (must provide proof of Mega PAC status to filing officer) (amended applications only)
O Political Party
Committee Name (required):
(must include parry affiliation)
Jurisdiction: G 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)
17 Legislative District Party (must Include proof of organization pursuant to A.R.S. § 16-823)
C City or Town Party (must include proof of qualification pursuant to A.R.S. § 16-802 or § 16-804)
Special Status 13 Standing Committee (must also complete separate standing committee registration)
(if applicable)
Arizona Secretary of State Revision 7/29/2021
13 Initial Application STATE OF ARIZONA COMMITTEE ID NUMBER
6Amended ApqlIcation COMMITTEE STATEMENT (ofnceuse only)
am:31 X2'I - 4 OF ORGANIZATION OV TG 1?9-o1
COMMITTEE INFORMATION:
MIRR 18724PM 3:81 TOV
Contact Information:
Committee's mailing address (required):: pis a� B -1 9 �/" `
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Zea Committee's email address (required): y002
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Committee's phone number (if any):
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Committee's website (if any): 1R0 L36--f O VW
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Chairperson's Information:
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Chairperson's name (required): LL17=oft{it'7k/t��r.7$B
Chairperson's physical address (required): of /V CJfLL��.�R�S1fl
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Chairperson's mailing address (if different): _Sdnr�E(
Chairperson's email address (required): Ec/�sr6eTH�Roti3t7l�'atoA�
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Chairperson's phone number (required): 5Z0 -
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Chairperson's employer (required): 645L F �6_1- 4i T}I rS U/tfcl]cp7
Chairperson's occupation (required): �IG ): -ML�2S
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Treasurer's Information:
Treasurer's name (required): oS WELL R •
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Treasurer's physical address (required): 111I) i ff P1,,
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Treasurer's mailing address (if different-):�SAM5
Treasurer's email address (required): 1C. eJ8G 2T!;a9
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Treasurer's phone number (required):: S ZO - 8 1
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Treasurers employer (required): �D
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Treasurer's occupation (required): 1'C�T'r IpL�l'r)_
Bank or Financial Institution:
Bank name (required): V"TnG7EQEST�:.Kt�
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(do not list acct numbers)
Additional bank name (if applicable): i NL
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Additional bank name (If applicable):
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DECLARATION AND SIGNATURES:
I declare under penalty of perjury that the foregoing information is true and correct. I further declare that 1: (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; (4) agree to comply with Arizona election law, including campaign finance laws codified at A.R.S.
§§ 16-901 to 16-936; and (5) agree to accept all notifi bons and legal service of process for campaign finance purposes via the email
address(es) provided herein. / . /
Chairperson's signature: v/h� Date; ISM442q
Treasurer's signature: Date: 3--/00—Z1(,
Candidate's signature (if applicable): _ Date: a /V r 2%
Arizona Secretary of State Revision 7/29/2021