Fillable COMMITTEE STATEMENT (office use only) Amended Application (first (City of South Tucson)

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COMMITTEE STATEMENT (office use only) Amended Application (first (City of South Tucson)

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The COMMITTEE STATEMENT (office use only) Amended Application (first (City of South Tucson) form is 2 pages long and contains:

  • 3 signatures
  • 38 check-boxes
  • 48 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of South Tucson

BROWSE CITY OF SOUTH TUCSON (AZ) FORMS

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Arizona Secretary of State Revision 11/5/16
COMMITTEE ID NUMBER
(office use only)
STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
Initial Application
Amended Application
Date: _______________
COMMITTEE TYPE (choose one):
Candidate
Committee Name (required):
(first or last name & office)
Candidate Information: Candidate’s Name (required):
Candidate’s mailing address (required):
Candidate’s email address (required):
Candidate’s phone number (required):
Candidate’s website (if any):
Office Sought (choose one): Governor Secretary of State Attorney General State Treasurer
Superintendent of Public Instruction State Mine Inspector Corporation Commissioner
State Senate State House of Representatives District (required):
County Office: District (if applicable):
City/Town Office: District (if applicable):
Election Cycle for Office Sought (year the election will take place) (required):
Party Affiliation: Democrat Green Libertarian Republican Other:
(required for partisan offices)
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: 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):
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)
Political Party
Committee Name (required):
(must include party affiliation)
Jurisdiction: State Party (must include 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)
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)
Special Status Standing Committee (must also complete separate standing committee registration)
(if applicable)
Arizona Secretary of State Revision 11/5/16
COMMITTEE ID NUMBER
(office use only)
STATE OF ARIZONA
COMMITTEE STATEMENT
OF ORGANIZATION
Initial Application
Amended Application
Date: _______________
COMMITTEE INFORMATION:
DECLARATION AND SIGNATURES:
Contact Information: Committee’s mailing address (required):
Committee’s email address (required):
Committee’s phone number (if any):
Committee’s website (if any):
Chairperson’s Information: Chairperson’s name (required):
Chairperson’s physical address (required):
Chairperson’s mailing address (if different):
Chairperson’s email address (required):
Chairperson’s phone number (required):
Chairperson’s employer (required):
Chairperson’s occupation (required):
Treasurer’s Information: Treasurer’s name (required):
Treasurer’s physical address (required):
Treasurer’s mailing address (if different):
Treasurer’s email address (required):
Treasurer’s phone number (required):
Treasurer’s employer (required):
Treasurer’s occupation (required):
Bank or Financial Institution: Bank name (required):
(do not list acct numbers) Additional bank name (ifapplicable):
Additional bank name (if applicable):
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.
Chairperson’s signature: Date:
Treasurer’s signature: Date:
Candidate’s signature (if applicable): Date:
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COMMITTEE STATEMENT (office use only) Amended Application (first (City of South Tucson)

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Completed 24 January 2021

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