Yavapai County Committee Statement Of Organization
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1
2YAVAPAI COUNTY
COMMITTEE STATEMENT
OF ORGANIZATION
Initial Application
Amended Application
DATE
ID# (office use only)
FOR OFFICE USE ONLY
COMMITTEE TYPE
(choose one)
CANDIDATE
COMMITTEE NAME (must include candidate’s first or last name and, if the candidate has a candidate committee open for more than one office, the office sought)
ELECTION CYCLE FOR OFFICE SOUGHT (year election will take place, required)
PARTY AFFILIATION (required for partisan offices)
Democrat
Green
Libertarian
Republican
CANDIDATE’S NAME (required)
Other:
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
Contributions
Recall Expenditures
Independent 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
Standing Committee (must also complete
Mega PAC (must provide proof of Mega
Corporation, LLC, Partnership, or Union
separate standing committee registration)
PAC status to filing officer, amended
applications only)
POLITICAL PARTY
PARTY NAME (must include party affiliation)
JURISDICTION
County Party (must include proof of qualification pursuant to A.R.S.
Legislative District Party (must include proof of organization
§ 16-802 or § 16-804)
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.
Revised 6/2017
Yavapai County Elections Department, 1015 Fair Street, Room 228, Prescott, AZ 86305
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