Bell,James_2023-CommitteeFormsStatement of Organization - Candidate Committee Is this statement:
New 0 Amended
Use this form to create a new or update an existing candidate committee.
This form must be accompanied by forth CRO -3500. An amended form is required for each new election Near
1. Committee Information
a. Name of Committee
d. ID Number
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b.Mailing Address (include City, state�)
e. Date Organized _
. Committee Website (Optional)
f. Phone Number
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2. Candidate Information
a. Full Name
e. Party Affiliation
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b. Mailing Address (Include City, State, and Zip Code)
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. Phone Number
d. Email Address
g. Nest Election year
h. Jurisdiction
❑ Email co of re ort notices
, Treasurer PIormation
4. Assistant Treasurer Information
. Full Name
a. Full Name
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. Mailing Address (include City, State, and Zip Code)
b. Mailing Address (include Cin. State and Zip Code)
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. Phone Nuumbersy
d. Email
c. Phone Number
d. Email Address
�Address p
Send report notices by email 1'esWG•No
Email ro v of re port notices
. Custodian of Books Information (Keeper of Records
6. Account Inf . CR041001
. Full Name
a. PloaoctalImtitu ion Full Name
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. Mailing Address (include City, State, and Zip Code)
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Phone Number
d. Emaa Address
b. Account Code ]c.
of
Type
Ej 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. I further certify that
this report is complete, true and correct.
XAWI ia' /h • 4LER
7-2/- 2623
Printed Name of Treasurer Signature of Appointe reasurer Date
I certify that the information above is correct, and I, as the candidate, appoint said treasurer to personally fulfill the
uties 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
Signature of C didate Dale
CRO -2100A ^C State Board of Election November 2019
AVROJT�E) NORTH CAROLINA
STATE BOARD OF ELECTIONS
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 filed at the Board of Elections office where the committee's campaign reports
are filed.
FILED BY:
Committee Name: J,ut•I5�o12 WxIi12.o ZhAQ ZjQ2
Treasurer Name: n gE L 4 -
Treasurer
Treasurer Address: f341 ,2&L1z4F Gdl..W
(include city, state, & zip)
Treasurer Phone: 704- Z82 -S' ?-V
Chec ne:
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. 163-278.1 OA. 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 $1,000 threshold. I will now be required
io file the next scheduled report for all contributions and expenditures that have not been previously
reported from the beginning of the current election cycle. I further agree to file all future reports required.
7—Z/- zo23 RECEIVED /{/�//J�ilzlel
Date Signed // Signature
JUL 2 1 2023
CRO -3600
„ Co. Board of Elections
Certification of Threshold
NORTH CAROLINA
STATE BOARD OF ELECTIONS
Certification of Financial Account Information
This Certification is used to report confidential bank account information for all financial accounts
established by the committee and must accompany the Statement of Organization Form
FILED BY:
Committee Name: .M
,4Aot2
Treasurer Name: �_yh '9F4L.
Treasurer Address: L941 1- , &/��F d4we j
(include city, state, & zip) LJa0=6)W �! 2$� 04
Treasurer Phone: :213q— 2S`7 —� p
I certify that the information provided below is true and accurate. I 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.
Type of account Financial Institution Address Account Number Account Code
11535- w iq,,.Wl-v Ot ,)61-45 FW401
J4e�o e
By signing! this statement, I authorize agents of the State Board of Elections to inspect all accounts provided.
Date Signed O� �,OV Signatureof CanVdie or Treasurer
For Candidate Committees Only
In lieu of providing account information, I certify that this committee will not raise any money not 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 bannk�cggp�that is being used for campaign expenditures.
By signing this statement, I autb?&,e agents of the State Board of Elections to inspect applicable accounts.
Date Signed ,& 2Q23 Signature of Candidate or Treaswer
660% Co. 6oatd of E�ec6ons
CRO -3 i00 Certification of Financial Account Information
2 1 2023
on Co. Board of Elections
VOTE NORTH CAROLINA
BOARD OF ELECTIONS
F— 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 filed at the Board of Elections office where the committee's campaign reports are filed.
Candidate Name: il-41
Committee Name: M24�3 Lt=62f LjEllypf' kwmM,4/n )z
Treasurer Name:
If Candidate is own treasurer, designate an agent to carry out designations: j y4 e1Z y &epw,,.)
Committee ID #: 1 7 OY — 6 ?LV— S7311:l
Level Registered: [State] [County] If county, specify: 01-/-a?Dti
I, _er.ZYl i- )SELL hereby direct that in the event of my death or incapacity all
(Name 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 Entity Plan for Disbursement (eg. Amount or
(Selectf am 9163-I7&168ra1)
1. &r c-) 7e.4L e"etf u-- d / coo
2.
3.
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 Committee
records.
Signature of Candidate:
Date: ?— 71— Zo73
CRO -3900
Candidate Designation ofConrmittee Funds