American Phoenix SuperPAC - FEC Statement of Organization - 10-14-2011

8/3/2019 American Phoenix SuperPAC - FEC Statement of Organization - 10-14-2011

1/6


2/6

r F E CFORM 1 STATEMENT OFORGANIZATION RECEIVE"02011 OCT ilf AH 9=0511. N A M E O F

C O M M I T T E E (In full)I""! (C heck if nameiLsk is changed)

Example: if typing, typeover the lines.

I l ngl< l \L\(K\ ' l \ T ^ ^ l ^ l ^ g ! ' ^ l ^ l K l iîUit^jgi f i ^ j O ^ ^| l 2 F E 4 M 5rF jnrrn nnrKnfnnnnnnnr ^.- rnrr- rr , ^ r ^nnnnr Hf jlî. m nmr n,*^n nry , -

I I 1 II I I ! 1. 1 1 I 1 I i I 1 I i I i I 1 I I I I

A D D R E S S (number and s treet) l \ i O l I i G i C g S j - V ! |(S i ' ^ Q i g i C i V v i O l V )| ^ 1 ^ i ^ i a P L l c \ Ii:;"' (Check if addressis changed)

J 1 1 L I l l l l

' l l i l l lCIT Y

C O M M I T T E E ' S E-MAIL A D D R E S S (Please provide only one e-m ail address)

J IfjCj | 3 , 3 , Q \ , Q M , ,STATE ZI P C O D E

| | (Check if addressis changed)|< ê ,g |()j^ ie ie ^V 5 ia ir|\ a | \ | ( ^ ^ i * A ^ M ^ i f i C O i m I I I I I I II i i I I I I i I I i I I i I ! I I I I I I I 1 I I I I i 1 I I

C O M M I T T E E ' S W E B P A G E A D D R E S S (URL)

[{ 1 (C heck if addr essii ss! is changed)l ^g ie i^ i ^ ig iaJ ba i r l> c \ > iC iQ iWr\I I I I 1 I i i

I i I I I I I I I I I IM i l

I I i

2. D A T E

3. F E C I D E N T IF IC A T I O N N U M B E R

4. IS TH IS S T A T E M E N T N E W (N ) O R I J A M E N D E D (A )

/ certify that I have examined this Statement and to the best of my knowledge and beliel it is true, correct and complete.

Type or Print Name of Treasurer

Signature of Treasurer Date 1 \ 0 ^ l '^ C > A \ ^NO TE: Submission of false, erroneous, or incomplete information may subject the person signing this Statement to the penalties of 2 U.S.C. 437g.

ANY C H ANGE IN INFORMATION SH O ULD BE R E P O R T E D WITHIN 10 DAYS.

L OfficeUseOnly F or further Information contact:Federal Election CommissionToll Free 800-424-9530Local 202-694-1100 FE C F O R M 1(Revised 02/2009) [


3/6

r F E C Form 1 (Revised 02/2009) Page 25. T Y P E O F C O M M I T T E E

CandidateCommittee:(a)(b)

This committee is a principal campaign committee. (Complete the candidate information below.)This committee is an authorized committee, and is NOT a principal campaign committee. (Complete the candidateinformation below.)

l l i l l lName ofCandidateCandidatePa rty Affiliation li

l i l l i I I I

OfficeS o u gh t: | J H o u se i t J S e n at e President State

(c) U This committee supports/opposes only one candidate, and is NO T an authorized committee.Name ofCandidate i I I I I I I I i I I I i I I i I I i I I I I I I I I I I I I I I i i I II I I I I I t I I ! I I I I ' i I ' I ' I I ' I I ' i ! ' ' I I ! i I I IParty Committee:i^) O Tl^'s committee is a

(National, Stateor subordinate) committee of the (Democratic,Republican, etc.) PartyPoliticalAction Committee (PAC):

M .I ^'^'^ committee is a separate segregated fund. (Identify connected organization on line 6.) Its connected organization is a:Corporation U Corporation w/o Cap ital Stock 4 ^ Labor Organization

U Mem bership Organization Q Trade Asso ciation | J CooperativeU ln addition, this committee is a Lobbyist/Registrant PAC .

(f) This committee supports/opposes more than one Federal candidate, and is NOT a separate segregated fund or partycommittee, (i.e., nonconnected committee)Q In addition, this committee is a Lobbyist/Registrant P A C .P J In addition, this committee is a Leadersh ip P A C . (Identify spons or on line 6.)

Joint Fundraising Representative:(g)(h)

L

This committee collects contributions, pays fundraising expenses and disburses net proceeds for two or more politicalcomm ittees/organizations, at least one of which is an authorized committee of a federal candidate.This committee collects contributions, pays fundraising expenses and disburses net proceeds for two or more politicalcomm ittees/organizations, none of which is an authorized committee of a federal candidate.

Committees Participating in Joint Fundraiser1. I I I I M I I I M I I I I2.

3.

4.J L

J F E C ID n u m b e r j CJ FE C ID number | (3

J F E C ID n u m b e r j Cj F E C ID n u m b e r | C

J


4/6

r 1F E C Form 1 (Rev ised 02/2009) Page 3

Write or Type Committee Name

6. Name of Any Connected Organization, Affiliated Committee, Joint Fundraising Representative, or Leadership PAC Sponsor

I I I I I I I I I I M I I II I I I I I I I I I I I 11 I I I I I M i I I I I I I I I I M I I I M M I I I I I

Mailing Address

i I IC ITY STATE ZI P C O D E

Relationship: O C onnected Organization O A ffi l iate d Comm ittee | J Joint Fundrais ing Representat ive j^ lL ea de rs h ip P A C Spon sor

7 . Cu s t od ia n o f R e c ord s : Identify by name, address (phone number - optional) and position of the perso n in pos ses sion of committeebooks and records.

F u ll N a m e i f k \ i ^L iVN Q i - e \ i l ^ e i V ii ^ a ^ m \ i V \ I I I I ! I I I i I i i I I I I 1 I 1 I IiV O iV i i6gaS iV i 6 t ^ . ^ c ! V T p W g L p i A .ailing A ddres s I \ \ l O C V i ^ i T j I T i ^ g ^ C ^ y p I C j ^ - i i l l l l l l i l l lI I. I I I I i I I I i I I I I I I .. I I 1 I . I 1 i I I I I I i I I I Il ^ ' i i ^ V - Q ^ e i : ^ ! I l l l l l l l l l L y l ^ i ^ ^ \ q - | I I I

Tit le or Posit ion C ITY ST A T E ZI P C O D E

T ? ] r e - < 5 i l i A ^ Y N V i I l l l l l l l l l Telephone number \ S > % | - - \ l s > 9 ' \ ^ \ I

8. Tr eas urer : List the name and address (phone number ~ optional) of the treasurer of the committee; and the name and address ofany designated agent (e.g., assistant treasurer).Full N a meof Treas urer I i i i i ! i i i i i i i i i i i i i i i i i i i i i i i i i i ! i i i IM ailing A ddre ss I i i i ! i i i i i i i i i i i I i i ! i i i i i i i i ' i ! I I I

I i I I I I I i I I I I I i I I I I I i I I I I i I i 1 I II i i i i i i i i i i . . I... I l i l i l l I 1 I I I 1 I I I ' l I I I I

C I T Y ST A T E ZI P C O D ETitle or PositionI l l l l l l i l l l i l l l l Telephone number | j | | - | I I |~ l I I I IL J


5/6

r ~iF E C Form 1 (Revised 02/20 09) Page 4

Full Name of^ 1 l l i i i l i i l i l i i l

Designated i l l ^ ^ L 1 * 4 ^Agent 1'^ V ltlt\|CM- i i i i i i i i i i i i i i I i i

I i I I I I I I 1 I i I I I I i I I I I I ' I I I I I I I I I I I IV i ^ l T ^ M M p l O ^ A l< ^;iS i I l l l l

CIT Y STATE ZI P C O D E

L J


6/6

Federal Elect ion CommissionE N V E L O P E R E P L A C E M E N T P A G E F O R IN C O M IN G D O C U M E N T ST he F E C added this page to the end of this filing to indicate how it was received.

Hand Delivered Date of Receipt

U S P S First Class Mai l Postmarked

U S P S Registered/Certi f ied Postmarked (R/C )

PostmarkedU S P S Priority MailD elivery C onfirmation or S ignature C onfirmation Label |

PostmarkedU S P S E xpress Mail

Postmark Illegible

No Postmark

Overnight Delivery Service (Specify): Shipping DateN ext Business Day D elivery

Received from House R ecords & R egistrat ion O ffice D ate of Receipt

Received from S enate Publ ic R ecords O ffice D ate of R eceipt

Received from Electronic Filing Office Date of Receipt

Other (Specify):

P R E P A R E R(3/2005)

Date of Receipt or Postmarked

D A T E P R E P A R E D

American Phoenix SuperPAC - FEC Statement of Organization - 10-14-2011

Documents

Transcript of American Phoenix SuperPAC - FEC Statement of Organization - 10-14-2011