Doyle,Gregory_2025-WaiverFORTH
TATE BOA
Mailing Address
P.O. Box 27255
Raleigh, NC 27611-7255
F EI
Phone
(919) 814-0700 or
(866) 522-4723
•
- I A REQUEST TO UEST A WAIVER OF
CIVIL LATE PENALTIES
TIONS PAGE 1OF2
Apolitical committee or referendum committee requesting a waiver of a civil late penalty under G.S. §163-278.34(a)
must complete and file this form with the State Board of Elections. 08 NCAC 21.0206.
• The form must be filed within 60 days of service of the notice of penalty assessment. 08 NCAC 21.0206.
• The State Board may waive a late penalty if it determines there is good cause for the waiver. Please include all relevant
facts or circumstances on this form. You may attach additional pages if necessary.
• An affidavit is a statement given under oath that its contents are true and accurate. By signing this affidavit form, you
swear, under penalty of perjury and other penalties established by North Carolina Law, that the information provided in
this affidavit is true, correct, complete, and of your own personal knowledge.
• Please note, this form will be disclosed to the public as provided in the North Carolina Public Records Act.
• The form maybe filed by mail to: NC State Board of Elections, PO Box 27255, Raleigh, NC 27611-7255, or by email to
campaign.reporting�7o ncsbe.gov. f you choose file by email, an original signed copy of the form must be retained for at
least two years counting from the date of the election to which the late report affects. 08 NCAC 21.0206.
• For more information, please review 08 NCAC 21.0206 or visit the State Board of Election's website at www.ncsbe.gov.
1
Information
About You
Gregory Edwin Doyle Jr.
Name
.202 South Stewart Street
Address
Wingate NC
City
State
gdoyle09@gmail.com 717-577-5060
E -Mail Address
Telephone Number
2 c re c, ov"_J E IDo�,i l e_ Ur being duly sworn, stated:
Sworn Affidavit Name
28174
Zip Code
1.1 am over 18 years of age, of sound mind, and I have personal knowledge of the facts stated herein.
2. 1 am a resident of urlio✓l Coyy\ty NC.
County and State of Residence
3. 1 am the: Authorized Candidate for ❑ Treasurer of
❑ Chair of ❑ Vice-Chairof
❑ Secretary of
Grego�r�j Edwin 1 E 21 -
Name of Committee
voM) NORTH CAROLINA
STATE BOARD OF ELECTIONS
AFFIDAVIT TO
REQUEST A WAIVER OF
CIVIL LATE PENALTIES
PAGE 2 OF 2
2 4. The committee was assessed a penalty by the North Carolina State Board of Elections on
Sworn Affidavit -L 23 2Y Zd ZV
(Continued) Dae of Penalty Report Year
3
Iw &
Jurat
❑
First Quarter Report
0 Mid -Year Semiannual Report
❑
Second Quarter Report
71 Year -End Semiannual Report
❑
Third Quarter Report
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❑
Fourth Quarter Report
❑ Municipal Report
5. On behalf of the committee, I am formally requesting a waiver of the penalty described in
paragraph 4.
6. Please describe all facts and circumstances you would like the State Board to consider in
reviewing your waiver request. Attach additional pages if necessary.
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7. The facts and circumstances described in this affidavit are true and accurate to the
best of my knowledge.
Signature of Affiant Date
State of North Carolina, County of
Sworn tof Qr affirmed) and subscribed before me,
This Q day of 20 c% 1
atIurof No ary P i
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Printed ame of Notary Puqlic:
My Commission Expires 41
Notary Stamp or Seat
°mem
Sandra L Coble
?NargR
NOTARY PUBLIC
Union County
North Carolina
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My Commission Expires
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July 4, 2029