Casanova,Ashley_2023-Amended-StmtOrgStatement of Organization - Candidate Committee Is this statement:
❑. r"W ❑ 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.
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a. Name of Committee d. In Number
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b. Mailim Ad ss (include'City, State and ZipCode), e:. ate Organized
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ci.Committee Website (Optional) f. Phone Number
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a. Full Name
e: PartyIAffiliation
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b.=Mailing Address (include City, State, and Zip Code)
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c. Phone Number, I tl,Email Address ,J .,�
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lh,Jurisdiction
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a. -Full Name .
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b:;Mailiug Addr .(include City, State, and ZijiCode)
b:Muifing Address (include City, State.andlZip Code),;:..`
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d. Email Address
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d. Email:Addri s
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Email copy of report notices
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a, FullName _;' _ ,` _
a. Financial Institution Full Name
b. Mailing Address (include City, State, andlZip'Code)•
C. Phone Number Id. Email'Address •'"
b:Account,Code
c. Type..,; 't `
Email cppy 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.
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Pri & Name of Treasurer Sen lure of Appointed Treasurer Date
I certify that the information above is correct, and I, 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. ^ 1
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PrUed Name of Candidate Signature of Candidate ' 15ate
CRO -2100A NC State Board of Elections November 2019