Casanova,Ashley_2023-Committee-formsStatement of Organization - Candidate Committee Is this statement:
❑ 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. ID Number
PrSweq C(34w."oyo. iv2 Ploneoe- MAgoe- (NC.)
0SMW&3
b. Mailing Address (include City, State and Zip ode)_ _
a.Date�
lCu S "—ov\r+sorJ St. fY\orrtoa) NC- 2'6112
-712.-1 12-o23
. Committee Website (Optional)
E Phone Number
9 3,42-9
2. Candidate Information
. Full Name
e. Party Affiliation
yFSV% « l-tg5gr1oV0.
-Re-PL) b i i cm�l
b . Maaing Address (include City, State, and Zip Code)
f. Office Sought
101a S 1okl"son $},
iMonaoc) NC 2-q 112
�'Abn ecx-
Number
d. Email Address
g. Next Election Year
6. Jurisdiction023
Vne
mail copy of report notices
3. Treasurer Information
4. Assistant Treasurer Information
. Full Name
a. Full Name
ols'wtq Ccasanovci'
. Malting Address (include City, State, and Zip Code)
b. Mailing Address (include City, State and Zip Code)
I�lo S �ohnSr�-� St
Moneoe NC 28112-
. Phone Number
Id. Email Address
c. Phone Number
it. Email Address
GAM -3429
0.41n1tyCn` tno lA22�rno (I .
Send re ort notices b email 1'es No
Email copy of re ort notices
5. Custodian of Books Information Keeper of Records
6. Account Information (bol. CRO -3500)
a. Full Name
a. Financial Institution Full Name
RECEIVED
b. hailing Address (include City, State, and Zip Code)
�yq
JUL 27 2M
Phone Number
Id. Email Address
-
fb. Account Codcl l�
Y
ta�0ard of EledW
- --- — —1
❑ 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.
nn p� n
CCtsanoyix L.tc�.C�YX ay- 7-7 20
Prided Name of Treasurer atuie of Appointed Treasurer Date
I certify that the information above is correct, and I, as the candidate, appoint said treasurer to personally fulfill the
plies and responsibilities imposed upon the appointed treasurer and subject to the penalties in Article 22A of Chapter
63 of the NC General Statutes.
1�
asw e4 l G15 - n ovt�
Printed Name of Candidate . ignarure of Candidate Da
CRO -2100A NC State Board of Elections November 2019
v NORTH CAROLINA
STATE BOARD OF ELECTIONS
Confidential
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:
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
Treasurer Phone:
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 remorts. 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.
By signing this statement, I authorize agents of the State Board o Elections to inspect all accounts provided.
Date igned C,9ignatwe of Candidate or Treasurer
In lieu of provatngaQcount information, I certify that this committee will not raise any money nor spend any money
except that which is the te's personal funds. I furthermore understand that an audit or investigation could
warrant the probe of any personal ba ount that is being used for campaign expenditures.
By signing this statement, I authorize agents of the oard of Elections to inspect applicable accounts.
z 3C E I V E D C
Date Signed Si
cable Candidate or Treasurer'
JUL 2 7 2023
Union Co. Board of Elec0n$
CRO -3500 Cell lifuntion ill Finmtcial Account bt/orrrm rims