Dotson,David_2023-Committee-formsStatement of Organization - Candidate Committee Is this statement:
❑ Ne' ❑ Ameoded
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. Committeelnformation - :: _.::.....,.
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"Nameorcomwitee .?i.-, 7 .', ... ,.: r, ,. �,• -.
..:- a.. �.. .,.,..- _ �.-_-,&IDNomber
Committee to Elect David Dotson
b: blafliag Address (include City; State md Zip Code)e
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Date organized -
wed_
PO
PO Box 1512, Monroe NC 28111
06/22/2023
Cemnxitfee Website (Optional)
Numbe%�`
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. Candidate: Information _ -
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Fail Name'i..�.. �_, `<_- .. ',• .;;:'
•
aPe 'Affiiadon.
William David Dotson
b: Mailing Address (include City, State, and Zip Code). -
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C Office_ Sougtit
PO Box 1512, Monroe, NC 2811'1
Monroe City Council
'.Phone Number „ d: Evian Address "' '
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t
i;. Next Election Year
b. Surisdictlon
984221-0788 dotsonformonroe@gmail.com
2023
❑ Email co of report notices
Treasurer Information - : '-
4. AssistautTreasurer Information
a. Full Name - ; ;'; - %
a. Foil Name"`9 - -
a N @
William David Dotson
ing Address (indode CHH Statewt[ ZipiCode) i-, <'
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b:llfailing Addreo (mdade City; State and Zip Code),
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d ie Nc agIIaeNumber
Ls'end
PO Box 1512, Monroe, NC 28111
;! d.EmaifAddress ',-
c Photie Numtier-..
d. Ein" Address'.•.AN9a•CA4984"221-0788
dotsonformonroe@gmail.com
reortnoticesb email',. - Yes`. No:-
U Email copy ofreport notices
S. Custodian of Books Information" e`e "er'of Records
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6: Account lnformatioa :- (x I=RO -3500) -< v
a. Full Nacrea.Fivaneial
lnstftodon Full Name -'-_:' •' -' -'
American Bank
b. Mailing Address (fodude City, State, and Zip Code)
312 N. Charlotte Ave
Monroe, NC 282112
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JUL1 2�
`'Phone Number• ".;
d.EmaB'Address
b. AccbnafCode. '
c:Type^`'-
704-220-6922Q
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❑ 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.
K42AVanu twat. ����lr�.,
Printed Name ofTseasmer Signature or 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.
William David Dotson — 06/23/2023
Printed Name of Candidate Signature of Candidate Date
CRO -2100A NC State Board of Elections November2019
�ED
2023
a(d ofi E1ecC�ons
tections
29M R
VOTE
rTTTt•
NORTH CAROLINA
STATE BOARD OF ELECTIONS
I 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.
FELED BY:
Committee Name:
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
Treasurer Phone:
41W/�,5� AA2 79112
-70�1 2Zi ��79
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 for candidate) must desienate 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.
//��By signing this statement, I authorize agents of the State Board/of Elections to it all �Ctou is provided.
t% (/�� �
ate Signed Signature of Candidatem—Treasmer
For Candidate Committees Only
J 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 this statement, I authorize agents of the State Board of Elections to inspect applicable accounts.
Date Signed Signatwe of Candidate or Ttea;u
CRO -3500 Certification offinancial Account Information
NORTH CAROLINA
STATE BOARD OF ELECTIONS
I 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: David Dotson
Committee Name:
Committee to Elect David Dotson
Treasurer Name: ti�gggCM774 DEJAI. ``'
If Candidate is own treasurer, designate an agent to carry out designations: RGrE
1 V
Committee ID #: A& 14 2
Level Registered: [State] [County] If county, specify: Union County nn A gpatd Of
1, 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
(Select from §163.278.16B(a))
1 Loaves and Fishes of Union County
2.
3.
Plan for Disbursement (ee. Amount or %)
100%
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. ��J%
Signature of Candidate: �" �m��"�
Date:
CRO -3900
06/23/2023
Candidate Designation of Committee Funds