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HomeMy WebLinkAboutCampaign Finance Records - Statement of organization - Responsible Leadership for Ocotillo - 1/16/20250 Initial Application I STATE OF ARIZONA COMMITTEE ID NUMBER M Amended Application COMMITTEE STATEMENT (office use only) Date: 1116I2025 Y OF ORGANIZATION IS _ d 1 J Y y COMMITTEE TYPE (choose one): CI 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): 0 County Office: ®CityfTown Office: ® School Board Office: 13 Special District Board: Mistrict (if applicable): ElDistrict (if applicable): ODistrict (if applicable): ODistrict (if applicable): Election Cycle for Office Sought (year the election wiit take place) (required): 2025 Party Affiliation: 0 Democrat El Green © Libertarian 0 Republican © Other. (required for partisan offices) M Political Action Committee (PAC) Committee Name (required): Responsible Leadership for ocotillo (if sponsored, must include sponsor's name) Political Function (optional): 19 Contributions ❑ Candidate -Related Independent Expenditures (select any that apply) ❑ Ballot Measure Expenditures 8 Recall Expenditures Sponsorship Information: (if applicable) Special Status (if applicable) 0 Political Party Committee Name (required): (must include party affiliation) Jurisdiction: Special Status (if applicable) Sponsors name or nickname (required): Sponsors mailing address (required): _ Sponsor's email address (required): T Sponsor's phone number (if any): Sponsor's website (if any): ❑ Separate Segregated Fund of a Corporation, LLC, Partnership, or Union ❑ Standing Committee (must also complete separate standing committee registration) ❑ Mega PAC (must provide proof of Mega PAC status to filing officer) (amended applications only) 0 State Party (must include proof of qualification pursuant to A.R.S. § 16-801 or § 16-804) 0 County Party (must include proof of qualification pursuant to A.R.S. § 16-S02 or § 16-804) © Legislative District Party (must include proof of organization pursuant to A.R.S. § 1"23) 0 City or Town Party (must include proof of qualification pursuant to A.R.S. § 16-802 or § 16-804) 0 Standing Committee (must also complete separate standing committee registration) Arizona Secretary of State Revision 7/29/2021 17 Initial Application S Amended Application Date: 1/16/2025 I COMMITTEE INFORMATION: Contact Information: Chairperson's Information: Treasurer's Information: Bank or Financial Institution: (do not list acct numbers) DECLARATION AND SIGNATURES: STATE OF ARIZONA COMMITTEE STATEMENT OF ORGANIZATION Committee's mailing address (required): 5838 W. Northview Ave 85301 Committee's email address (required): homers4@msn.com Committee's phone number (if any): 6236953620 Committee's webs€te (if any): Chairperson's name (required): Derek M. Vukusich Chairperson's physical address (required): 5838 W. Northview Ave 85301 Chairperson's mailing address (if different): Chairperson's email address (required): Dvukusich@gmail.com Chairperson's phone number (required): 4803833776 Chairperson's employer (required): phoenix Childrens Hospital Chairperson's occupation (required): Remote Endpoint Support Treasurers name (required): Kathleen Collins Treasurers physical address (required). 5820 W. Northview Ave85301 Treasurers mailing address (if different): Treasurer's email address (required): Kmorocoo@live.com Treasurer's phone number (required): 4809385593 Treasurer's employer (required): Retired Treasurers occupation (required): Retired Bank name (required): Wells Fargo Additional bank name (if applicable): Additional bank name (if applicable): COMMITTEE ID NUMBER (office use only) L_ declare under penalty of pejury 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 receivelmake contributions/expenditures on my behalf, it 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: Treasurers signature - Candidate's signature (if applicable): Date: 01/16/2025 Date: 01/16/2025 Date: Arizona Secretary of State Revision 7/29/2021