Fillable NAVAJO COUNTY COMMITTEE STATEMENT OF ORGANIZATION Democrat Green (Navajo County)

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NAVAJO COUNTY COMMITTEE STATEMENT OF ORGANIZATION Democrat Green (Navajo County)

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The NAVAJO COUNTY COMMITTEE STATEMENT OF ORGANIZATION Democrat Green (Navajo County) form is 2 pages long and contains:

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  • 5 check-boxes
  • 100 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Navajo County

BROWSE NAVAJO COUNTY (AZ) FORMS

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Revised 1/2017 Page 1 of 2
NAVAJO COUNTY
COMMITTEE
STATEMENT OF
ORGANIZATION
FOR OFFICE USE ONLY
Initial Application Amended Application
DATE
ID# (office use only)
COMMITTEE TYPE (choose one)
CANDIDATE
COMMITTEE NAME (must include candidate’s first or last name and office)
ELECTION CYCLE FOR OFFICE SOUGHT (year election will take place, required)
Democrat
Green
Libertarian
Republican
Other:
CANDIDATE’S NAME (required)
CANDIDATE’S MAILING ADDRESS (required)
CITY
STATE
ZIP
CANDIDATE’S EMAIL ADDRESS (required)
CANDIDATE’S PHONE NUMBER (required)
CANDIDATE’S WEBSITE (if any)
OFFICE SOUGHT (required, choose one)
Assessor
Recorder
Attorney
School Superintendent
Board of Supervisors – District:
Sheriff
Clerk of Superior Court
Superior Court Judge – Division:
Constable – Precinct:
Treasurer
Justice of the Peace – Precinct:
School District Governing Board – District:
Special District Board (fire, water, sanitation, hospital, road, etc.) – District:
Political Action Committee (PAC)
COMMITTEE NAME (if sponsored, must include sponsor’s name)
POLITICAL FUNCTION (optional) (choose any that apply)
Ballot Measure Expenditures
Candidate-Related
Independent Expenditures
Contributions
Recall Expenditures
SPONSORSHIP INFORMATION (if applicable)
SPONSOR’S NAME OR NICKNAME (required)
SPONSOR’S MAILING ADDRESS (required)
CITY
STATE
ZIP
SPONSOR’S EMAIL ADDRESS (required)
SPONSOR’S PHONE NUMBER (if any)
SPONSOR’S WEBSITE (if any)
SPECIAL STATUS (if applicable)
Choose one
Separate Segregated Fund of a
C
orporation, LLC, Partnership, or Union
Standing Committee (must also complete
s
eparate standing committee registration)
Mega PAC (must provide proof of Mega
P
AC status to filing officer, amend
ed
applications only)
POLITICAL PARTY
PARTY NAME (must include party affiliation)
JURISDICTION
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)
SPECIAL STATUS (if applicable)
Standing Committee (must also complete separate standing committee registration)
Please complete both sides of this form.
Navajo County Elections
Department, 100 E. Code Talkers Dr., P.O. Box 668, Holbrook, AZ 86025
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signature
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FOR OFFICE USE ONLY
Entered in database Posted to navajocountyaz.gov
Revised 1/2017
Navajo County Elections
Department, 100 E. Code Talkers Dr., P.O. Box 668, Holbrook, AZ 86025
Page 2 of 2
COMMITTEE INFORMATION
COMMITTEE’S MAILING ADDRESS (required)
CITY
STATE
ZIP
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)
CITY
STATE
ZIP
CHAIRPERSON’S MAILING ADDRESS (if different)
CITY
STATE
ZIP
CHAIRPERSON’S EMAIL ADDRESS (required)
CHAIRPERSON’S EMPLOYER (required)
CHAIRPERSON’S PHONE NUMBER (required)
CHAIRPERSON’S OCCUPATION (required)
TREASURER’S INFORMATION
TREASURER’S NAME (required)
TREASURER’S PHYSICAL ADDRESS (required)
CITY
STATE
ZIP
TREASURER’S MAILING ADDRESS (if different)
CITY
STATE
ZIP
TREASURER’S EMAIL ADDRESS (required)
TREASURER’S EMPLOYER (required)
TREASURER’S PHONE NUMBER (required)
TREASURER’S OCCUPATION (required)
BANK OR FINANCIAL INSTITUTION INFORMATION DO NOT LIST ACCOUNT NUMBERS
BANK NAME (required)
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 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
X
DATE
TREASURER’S SIGNATURE
X
DATE
CANDIDATE’S SIGNATURE (if applicable)
X
DATE
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NAVAJO COUNTY COMMITTEE STATEMENT OF ORGANIZATION Democrat Green (Navajo County)

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Completed 9 August 2020

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