Bivens,Margaret_2023-SOStatement of Organization - Candidate Committee is is statement:
bUnNew ❑ Amended
Use this forth 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
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a. Name of Committeed.
1 D Number
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. Nailing Address (in CI!)', Staa and Zip Code)
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a Date Organized
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. Committee N%ehsite (Op - nal)
I. I'hone Nuinber
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2. Candidate Information
. Full Name
.Party Atnaation
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b. Mailing . ddress (inclaile City. State, and lip Code)
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600 ) Wask. ion S � - —
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. Phone Number
it. Email Address
g. Next Election Year
Is. JorlMktion
-7014 • b214-JV69
❑ Email copy of report notices
3. Treasurer information
4. Assistant Treasurer Information
. Full Name
a. full Name
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. Mall Address (Include City, State, and Zip Code)
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b. Mailing Address (include City. State and Zip Code)
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. Phooe Number
d. Email Address
c. Phone Number
d. Email Address
jOL4 6.14-,244
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En1ai1 cu ul re on notices
. Custodian of Books Information (Keeper of Records
6. Account Information (met.. CRO -3500)
. Full Name
a. Financial Institution Full Name
b. Mailing Address (include City, State, and Zip Code)
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!UL 0 7 2023
. Phone Number
lit. Email Address
It. Account Code
c.
❑ 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 is complete, true and correct.
/r,Fport
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Printed Nana of Treasurer S
aire of Appoi ted treasumir 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
1163 oo.,f I NC General Statutes.
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Printed Name of andidate
ignature of Candidate Date
CRO -2100A NC State Board of Elections November 2019