HomeMy WebLinkAboutCommittee to Elect Melanie Barrett - Statement of Organization - 6/13/2018 `O lnitial Appiica#ion � T��N �F ��� VQ►�...�.,.�Y Ct)MM1TT'EE iD NUMBER
�Amended Application �[ CQMMITT� ,.. STATEMENT (o�ce use on�Y}
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� Date: ���,-1� ��'�1"� �� ,.ci
, t�F t�E�GANIZATItJN
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C4MMITTEE TYPE(choase ane):
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/ �Candidate
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Committee IVame re uired : ��1 � t `� � �
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�andielate irrformation: Candidate's Name re uired : _�t� � � �"f���
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! Candidate's mailing address(required): �� L � • � 7,l��� � � � �� -
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� Candidate's email address(required): ��l�'���Y�i��� �1��.=��1�1}�������'�,:'��-���`
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Candidate s phane number(required): .� �..�'..�-� �.
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j Candidate's website(if any); �r�,��1,� r h��,��Y�!�� �Jl�' :�� • ��`
� r f t �Attorne Genera( ❑Sta#e 7reasurer
Office Sought{choose one). (�Governor [�Sec etary o Sta e y
❑Superintendent of Public lnstruction C7 State Mine lnspector ❑Corparatian Commissioner
❑State Senate Cl State House of Representatives ❑District(required�:
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Cl County Q�ce: C]District(if applicable�:
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� �CityfTown Uffice: ��������i � CI pistrrct(if applic�ble}:
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� Elec�ion Cyc/e for O�ce Sought�year the election will take place)(required): �..��� �
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� Party Affilia�ion: ❑Democrat Cl Green CJ l.ibertarian ❑Republican �(Jther:
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` ❑ Political Action Commit#ee(PAC�
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f Commi�tee Name(required�:
� �if sponsored,must include �
� sponsor's name)
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� Palitical Function(opt'ronal}; L7 Contributions C7 Candidate-Reiated tndependent Expenditures
(select any that apply} ❑Ballot Measure Expenditures ❑Recall Expenditures
� Sponsorship lnfarmation: Sponsor's name or nickname(required):
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� (if applicable) Sponsor's mailing address(required):
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� Sponsor s ema�l address(required):
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; Sponsor's phane number(if any):
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� Sponsor's website(if any): ;
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� Special Status C�Separate Segregated Fund of a Carporation,LLC,Partnership,or Union
�' �f a l�cable ❑Standin Committee must also com lete se arate standin comr�ittee re istration
�� PP� ) 9 ( P p 9 9 )
C7 Mega PAC(must provide proof of Mega PAC status to filing officer)(amended applications only)
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C7 Politica!Party
� Committee Name(required):
(must include party affiliatian}
Jurisdictian: ❑State Party(must include proof of qualification pursuant ta A.R.S.§16-8�1 or§16-804} {
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❑County Party{must include proof of qualification pursuant to A.R.�.§16-8�2 or§1fi-�8�4}
❑Legislative District Party(must include proof of organization pursuant tv A.R.S.§16-823}
� Cl City or Town Party(must include proof of qualification pursuant to A.R.S.§16-8a2 or§1fi-804)
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� Special Status ❑Standing Committee(must alsa compl�te separate standing committee reg+stration)
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` (if appficable)
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Arizona Secretary of State Revision 1115/1 fi
o i��t;a�App�;��t;on TC�WN C�F C�RC} VAI.LEY COMMITTEE ID NUMBER �
�(Amended A�plicatian ` � � �C�MMITTEF STAT�MENT (office use aniy) ;
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�ate: —t� �- ! f\ OF C)R�AN IZATIC)N __.�.,_�.._.. _._._. �
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COMMfTTEE lNFQRMATIUN:
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� Cantact In�ormation: Cammittee's mailing address(required): 1� _� �� �' �'i�` ���. ��� ��� ��� ��;
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� Committee's email address(r�quired�: �� ' �.. 1 - Y' - - ��C�` '
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� Committee's phone number(if any): ��� M.��.��-� ,
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Committee's website(if any): �� � � � �' �� � *��(" �
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i Chairperson's Information: Chairperson's name(required): _���' �11�1�. �����'�`-�
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� Chairperson's physica!address(required)_ �.���`� � �1���' �1{��� ��� ��� ��.� �� ���
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� Chairperson's mailing address(if different}: �' �
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Chairperson's emai!address(required): �� - �. � •
Chairperson's phone number{required): '��� ��=��~- ���.�
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� Chairperson`s employer(required}: ""'�' j
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� Chairperson's accupation(required}: �� �h ����'-�
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� Treasurer's Information: Treasurer's name(required): �`� 1 � C'�C�C `���
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; Treasurer's physical address(required):`�'��`,�� �� �����J��` ���,�.��,. ��_ ��� �.�� l�'�; ���
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` Treasurer's mailing address(if different): � �
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� Treasurer's email address(required�: � �' C1 L�, �'Y1 1 °
Treasurer's phone number(required): � �C� R�-..�����-
Treasurer's employer(required): �
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Treasurer's occupation(required): � � �
`� Bank or Financial Institution: Bank name(required): � �
� (do not list acct numbers) Additional bank name(ifapplicable�: �
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�� Addi#ional bank name(if applicable):
DECLARATION AND SlGNATURES:
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I declare under penalty af perjury that the foregoing information is true and correct.1 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 Ari2ona electian law,including campaign finance laws codified at A.R.S.
§§16-901 to 1 fi-938;and(5�agree to accept all nofificatians and legal service of process for camp�ign finance purposes via the email
address(es}provided herein.
Chair erson's si nature: �t pate: lL�' I��
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Treasurer s si nature: � �� '�� , � Date: i �
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�� Candidate s s gnature(if app cable): �f � � Date: f
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Ari2ona Secretary of State Revision 11/5/16