HomeMy WebLinkAboutCommittee to Elect Melanie Barrett - Statement of Organization - 5/18/2018 �Initial Application TOVIIN OF ORO VALLEY COMMITTEE ID NUMBER
0 Amended Application ' '�- COiVI M ITTEE STATE M E NT (o�ice use on�y)
Date: 0
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COMMITTEE TYPE(choose one): .
�Candidate
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Committee Name(required). G�1 -e �
(first or last name&office)
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Candidate Information: Candidate's Name(required): ��1����. �1�CY��"�
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Candidate's mailing address(required): �3��1� N� S��� 1l�����1 P�� �Y�`}Q gs
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Candidate's email address(required�: � e� 1 r • Y
Candidate's phone number(required): J� �3��- ��
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Candidate's website(if any): • � • �
Office Sought(choose one): �Govemor ❑Secretary of State ❑Attomey General ❑State Treasurer
�Superintendent of Public Instruction �State Mine Inspector 0 Corporation Commissioner
�State Senate O State House of Representatives �District(required):
❑County Office: ❑District(if applicable):
.
�.City/Town Office: � ❑District(if applicable):
Election Cycle for O�ce Sought(year the election will take place)(required): ����
Party A�liation: ❑Democrat ❑Green �Libertarian 0 Republican ❑Other:
(required fo�partisan offices)
0 Political Action Committee(PAC)
Committee Name(required):
(if sponsored,must include
sponsor's name)
Politica/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):
Sponsor's email address(required):
Sponsor's phone number(if any):
Sponsor's website(if any):
Specia/Status 0 Separate Segregated Fund of a Corporation,LLC,Partnership,or Union
(if applicable) ❑Standing Committee(must also complete separate standing committee registration)
0 Mega PAC(must provide proof of Mega PAC status to filing officer)(amended applications only)
0 Political Party
Committee Name(required):
(must include party affiliation)
Jurisdiction: O State Party(must indude proof of qualification pursuant to A.R.S.§16-801 or§16-804)
�County Party(must include proof of qualification pursuant to A.R.S.§16-802 or§16-804)
0 Legislative District Party(must include proof of organization pursuant to A.R.S.§16-823)
❑City or Town Party(must include proof of qualification pursuant to A.R.S.§16-802 or§16-804)
Specia/Status ❑Standing Committee(must also complete separate standing committee registrabon)
(if applicable)
Arizona Secretary of State Revision 11/5/16
�Initial Application TOWN OF ORO VALLEY COMMITTEE ID NUMBER
� Amended Application COMMITTEE STATEMENT (office use on�y)
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COMMITTE E I NFORMATI ON: .�� �-�' -���`*� � �--
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Contact Information: Committee's mailing address(required): �3 �S� ^ �� 01�0 � �5
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Committee's email address(required): •
Committee's phone number(if any): s2� 333—7�Z�J
Committee's website(if any):
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, Chairperson's Information: Chairperson's name(required):
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Chairperson's physical address(required): • .� . �Y� Qtl
Chairperson's mailing address(if different): �S 5
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Chairperson's email address(required): �1r , � r
Chairperson's phone number(required): ��28� 3 33�—��Z3
Chairperson's employer(required): '"��
Chairperson's occupation(required): � ��
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Treasurer's Information: Treasurer's name(required): �J a �
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Treasurer's physical address(required): 1�y� �� S 1 IV�r 1:,�1 Q 'f�� 4�0 �� ` �7
T�easurer's mailing address(if different):
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Treasurer's email address(required): � • �r
Treasurer's phone number(required): 'Jr b �.3 3' y�
Treasurer's employer(required): `-'—'
Treasurer's occupation(required): �0 Y��Q,1(Yl Q K—e r'
Bank or Financial Institution: Bank name(required):
(do not list acct numbers) Additional bank name(ifapplicable): D�
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;(4)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 accept all notifications and legal service of process for campaign finance purposes via the email
address(es)provided herein.
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Chairperson s signature: Date: �
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Treasurer's si nature: Date: V
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Candidate's signature(if applicable): Date: �g
Ariiona Secretary of State Revision 11/5/16