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HomeMy WebLinkAboutErceg for OV - Statement of Organization - 1/12/2022 . _ . ... . . . � .. ..:, r ..t ..� . . , . .. .��.� . .-�-. , .:::- i K.,,;"� . � .... . . : s .,.' ��. ."�,. . .��.:.. . . , .: . '.� .: :�.. ... ., :. . �-. , ..,�.. . . , . �''' '. '��. i . .. ..;� . . _ ._ ... .... ., . .. .. - _ �:�. . � ., � . ,.. , . ... . � ,. ., . �... . . . . �'�- • .5�.:�- '.. � '� ..� .:r .. ,. . , . . ,.. . . . .. , .. . �,. �. . .. .. . . , .... . . . .�- ., .. .. . . .. ., . , .. . . . �. � .:��;. „ :.:,�. ,..�� ;•.: � , '::..� �.... ..:..'. . ',.; . . . ; -_:.. ,n�., ,k+'�. � _ � _ ..:: ,.: ........ , ,..,. ...�., .: �... .. . - �- . . . , -.,+.. :�,,.., ...... �....a.. . z�_.. . ..:... .-,... .. �,:��..'• ���-:'. . �:." �,. ; �. „ ...'......... . ..._ ...� . .... 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G.�i t.i f � . . .. . .. . . �3��-�. nitial Application STATE OF ARIZONA COMMITTEE ID NUMBER o Amende Appii tion �� C O M M ITT E E STAT E M E N T (off�ce use on�y) Date: '��� '����.. o�, ��� � � OF ORGANIZATION � COMMITTEE TYPE(choose one): � Candidate f Committee Name re uired : ��� `—� �V i t q ) (first or last name&office) � � � ���� Candidate Informatron. Candidate s Name re uired . �_..� � � q ) _ ..,...— Candidate's mailing address(required): .V s. '�- � � �2� ��" -� Candidate's email address(required): 1s � , � � ;1�( '�J► � Candidate's phone number(required): � � � � � Candidate's website(if any): � � � �-� O�ce Sought(choose one): 0 County Office: ._ C7District (if applicable}: r ,, ❑City/Town O�ce: - �� � � �. �District(if applicable): ❑School Board Office: O District(if applicable): �Special District Board: ODistrict(if applicable): E/ection Cycle for Office Sought(year the election will take place)(required): � � Party A�liation: �Democrat �Green ❑Libertarian ❑Republican �Other: (required for partisan o�ces) F] Political Action Committee(PAC) Committee Name(required): (if sponsored,musi include sponsor's name) Political Function(optionai): ❑Contributions ❑Candidate-Related Independent Expenditures (select any that apply) O Ballot Measure Expenditures ❑Recall Expenditures Sponsorship lnformation: 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): Specia/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) 0 Politica(Party Committee Name(required): (must include party affitiation) Jurisdiction: �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.§16-802 or§16-804} E�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) Specia/Status �Standing Committee(must also complete separate standing committee registration) (if applicable) Arizona Secretary of State Revision 7/29/2021 ; _. . ...,. .� .� ;_.. `,� . _ _ -, ���,,,z .:: ; ; -, ,� , _ . , .. ;�;- , f�. � }� ::. � : ` ; ; . ���� . _ ,. �- ;. , .: _ , , St. ,", , . . . .� .. ._. ' .��. . � � � '� . �. �` ,.�� �. .:. . : . . � ..� . . _...�...... ._...,v....>..... ._n..._....�._�...,..�...._........... �') . ..�.�.. � ..� .. . .. . . . . ... .,....,..w_y.....,...x,i i............._ .i.._. .,.__.,...... ...._.._........._.._........_ __..... . __.._ ......... . .... . _.... ._..... /e.�,•S:'.�.Y'Y;t7.mi'4i...u.✓ia�'Jd:n�s..,tw�r:af�i.`.;:ir�eJ...r.a,.��-�..�...»���....i,-:..:�... .�:.:::.. ..:.._':.:�.....i.....�......e�..�r_.�awu..a�.�av.«ar.+.�_....r_.,.+.P,�r...ra,.__...�..._.«.......... . Y�. ��� �K:w' .�w:j'�1.;. ': i�h. t".y `,r,_1,-� :s � i ����} :�f��? ..,�- ...�:..'", ,� . � �- initial Appiica#ion STATE OF ARIZONA COMMITTEE ID NUMBER 0 Amend d Ap ication ����=�� COMMITTEE STATEMENT (office use oniy) �ate: ' � �� Y F ORGANIZATfON � � O COMMITTEE INFORMATION: Contact Information: Committee's mailin address re uired : - � �� � � � ��� `�1� l 9 ( q ) � Committee's email address(required): ��C-��� �^ �'; �'`�t� � �-�r�1 ' I y� � ����.. Committee s phone number(if any): Committee's website(if any): �� v '''(��� ��'�� y Chairperson's Information: Chairperson's name(required): � , Chairperson's physicai address(required): � � � !� � � � Chairperson's mailing address(if different): _ ;�"�+_� . Chairperson's email address(required): t1 ' 'S I'}'1 C'..�.�1 , �t'b✓1 Chairperson's phone number(required): � �' J?� Chairperson's employer(required): (�����G�( /vr���� �L��'1'1i�'11�'�'�I I����1�l�S� � � Chairperson's occupation(required): 1r'�L�-� '�C �" IJ''?. � !C- �� G� �� �ls ..--- Treasurer's lnformation: Treasurer's name(required): 1� � l/��`�'�'�� �— � �►� � Treasurer's physical address(required): � � � � �C Treasurer's mailing address(if different): . Treasurer's email address(required): � l�'1�� �L� �L�{G��`��1 seh 1'�'l 4�h �G�'m � �f Treasurer's phone number(required): � ��7 � "`1 �� a Treasurer's employer(required): � ��C� �� rJG-�'1 i'✓�dt n � � Treasurer's occupation(required): C�- .����t / t �- G�-�ry �� � �,� _• ,, , � .. Bank or Financial Institution: Bank name(required): � � �� (do not list acct numbers) Additional bank name(if app(icable): Additional bank name(if applicable): DECLARATION AND SIGNATURES: !declare unde�penalty of perjury that the foregoing information is true and correct.I further declare that(:(1)consent to serve as chairperson or treasurer of the committee named herein,if applicable;(2)designate the above-n .�d committee as my official candidate committee and authorize it to receive/make contributions/expenditures on my behalf,if � a le;(3)have read the Secretary of State's cam aign finance and reporting guide� 4 agree to comply with Arizona electio ,including campaign finance laws codified at A.R.S. P §§ 16-901 to 16-938;and(5)a o acc pt all notifications and legal ice of process for campaign finance purposes via the email address(es)provided here' . .i. r,,,.. yr' , -- / 2 --�- Chairperson s signature: Date: Treasurer's signature: Date: � � �Z� Candidate's si nature if a licable : Date: ��� 9 � PP ) Arizona Secretary of State Revision 7/29/2021