Beckwith,David_2023-Committee-formsStatement of Organization - Candidate Committee Is ytis statement:
Ef New ❑ Amended
Use this form to create a new or update an existing candidate committee.
This form must be accompanied by form CRO -3500. An amended form is required for each new election year.
1. Committee Information
a. Name of Committee
d. 1 D Number
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. Matting. Address (InNmle City, State and Zip Code)
e. Date Organized
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. Committee Website (Optional)
f. Phone Number
2. Candidate Information
. Full Name
e. Party Affiliation
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. )tailing Address (include City, State, and Zip Code)
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. Phone Number d. Email Address
g. Next Election Year
h. Jurisdiction
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Email copy of report notices
3. Treasurer Information
4. Assistant Treasurer Information
. Full Name
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a. Full Name
N I A,
. Mailing Address (include City, State, and Zip Code)
b. Malting Address (include City, State and Zip Code) -
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. Phone Number
d. Email Address,
c. Phone Number
d. Email Address
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Email copy of report notices
5. Custodian of Books Information (Keeper of Records
6. Account
Information (incl CRO -1500)
. Full Name
Nj
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a. Financial Institution Full Name
h. Mailing Address (include City, State, and Zip Code)
JUL 18 2023
. Phone Namber Id. Email Address
b. Account Code _
a Type -c-O -BMtCi of
❑ Email copy of report notices
I certify that the Committee is in compliance with all applicable provisions of Article 22A of Chapter 163 of the NC
General Statutes and that no funds are commingled with prohibited or other non -disclosed funds. 1 further certify that
this report is complete, true and correct,
noted Name of Treasurer Signa of Appointed Treasurer Date
I certify that the information above is correct, and 1, as the candidate, appoint said treasurer to personally fulfill the
duties and responsibilities imposed upon the appointed treasurer and subject to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
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Printed Name of Candidate W atme of Candidate D e
CRO -2100A NC State Board of Elections novemoer m tr
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NORTH CAROLINA
STATE BOARD OF ELECTIONS
Certification of Financial Account Information I
This Certification is used to report confidential bank account information for all financial accounts
established by the committee and must accompany the Statement of Organization Form.
FILED BY:
Committee Name:
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
Treasurer Phone:
1 .' ..' • to M0
I certify that the information provided below is true and accurate. t am providing all account information for the above
named Committee. These account numbers include all bank accounts utilized, credit card accounts, money market or
savings accounts, or any other financial account used for any purpose by the Committee.
The information provided on this form is considered confidential and is not subject to public disclosure. The information
provided is only used for the purposes of an audit or investigation or as required by a court of competent jurisdiction.
Each treasurer (or candidate) must designate below an account code (any number or letter or combination of
numbers and letters) by which to refer to the account number on reports. If an account number is used as the "account
code," confidentiality of the account number is presumed to have been waived.
The treasurer shall maintain all moneys of the political committee in a bank account or bank accounts used exclusively by
the political committee and shall not commingle those funds with any other moneys.
Tvne of account Financial Institution Address
Account Number
Account Code
By signing this statement, 1 authorize agents of the State Board of Elections to inspect all accounts provided.
Date Signed raNre of Candidate or Trenurer r '
For Candidate Committees Only
of In lieu of providing account information, I certify that this committee will not raise any money nor spend any money
except that which is the candidate's personal funds. I furthermore understand that an audit or investigation could
warrant the probe of any personal bank account that is being used for campaign expenditures.
By signing t is statement, I authorize agents of the State Board of Elections to inspect applicable accounts.
i /a
ate Signed Nre of Candidate or Treasurer
RECEIVED
JUL 18 2023
CRO -3500 Certification of Financial Account Infbrmation
RTH CAR
ELECTI
Certification of Threshold
This Certification is used to declare or withdraw a committee's intent to raise or spend $1,000 or less in the
current election cycle.
This Certification is only valid for political party committees and candidates for a county office,
municipal office, local school board office, soil & water conservation district board of supervisors, or
sanitary district board.
This Certification is riled at the Board of Elections office where the committee's campaign reports
are filed.
FILED BY:
Committee Name: i.-.)7
Treasurer Name: M ;5 j
Treasurer Address:1 i 779 �„ i�,^, i e
(include city, state, & zip) /�iyn/OC r ,A16 . -i.. 911 0
Treasurer Phone: -7a It- �z 7 G- e 2 1 f;
Check One:
�/ 1 certify that this committee intends to neither receive nor expend more than $1,000 during the current
election cycle under the procedures set forth in G.S. 163-278.10A. This certification will remain in effect
until the end of the election cycle for this committee. If this committee exceeds $1,000 in contributions or
expenditures during this election cycle, I understand that I must immediately notify the appropriate board
of elections and file required campaign finance reports.
THIS DECLARATION CAN ONLY BE MADE AT THE BEGINNING OF AN ELECTION CYCLE.
I am withdrawing my Certification to remain at or under the $1,000 threshold. 1 will now be required
to file the next scheduled report for all contributions and expenditures that have not been previously
reported from the beginning of the current election cycle. i further agree to file all future reports required.
[Date Signed
CRO -3600
RECEIVED
JUL 18 2023
Certification q/'ihrerhold Union Co. Board of Elections
10 --TVI NORTH CAROLINA
STATE BOARD OF ELECTIONS
Candidate Designation of Committee Funds
This form is used by candidate committees only and allows the candidate to designate in the event of their death,
how the committee's funds are to be disbursed using the eight allowable methods outlined in 163-278.16B(a).
This Designation is Bled at the Board of Elections office where the committee's campaign reports are filed.
Candidate Name: D &U l 41 he ellp AA:)
Committee Name: '7-75 'jfgeiS�-\
Treasurer Name:
If Candidate is own treasurer, designate an agent to carry out designations:
Committee ID #:
Level Registered: [State] [County] If county, specify:
CEk_(t L� J , hereby direct that in the event of my death or incapacity all
m
(Nae of Candidate)
funds remaining in my Campaign Committee account(s) (after payment of permitted outstanding
debts or reasonable expenses for winding up the Committee or closing office) be paid in the
following manner as permitted by N.C. Gen. Stat. 163-278.16B(a).
Name of Entitv
Select rom 163-278.168 a
Plan for Disbursement (eg. Amount or %)
mall, MM
e
2.
3.
RECEIVED
2023
By signing this form, I certify that the foregoing entities are eligible beneficiaries under N.C.
Gen. Statute 163-278.16B(a). A copy of this form should be maintained with the COP&PAeBoard of Elect ,
records.
Signature of Candidate:
Date: -711 2
CRO -3900
Candidate Designation of Committee Funds