Dukes,Larry_2023-Committee-formsStatement of Organization -.Candidate Committee Is this statementF:
IJ0 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 reouired for each new election year.
1. Committee Information
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.. Name Committee—..
dlDNamber __.. ....
�of�C^ommrit—/.'
E�-C �l t -" Ley, Ylt� s
-.-Mailing Addrem (include City, State and Zip Code) - - , ` ,.• • _ _ - -
e. Date Organized -. =
' Committee Website( PO h -
on
(.Phone Number
�oY-99g-�Y3
2. Candidate Information
". Full Name r ..., :'. ,,' _ ".
e. Pan Atfiliatlou .' ` .. _ -....
La.ulre."Ce
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b. Moiling Address (include City, Stntq�and Zip Code)- -f`biDce
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/T T WAJ L'OUiIfGLL
.Phone Number" s
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. Emati Address , 1" _
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g.Nert Election Year' '.-,
h. Jarisdic8on.. .:
7oY•99f -IFg3
10!22,l7-00VAat'l „aa;tl-
❑ Email co of report notices
Treasurer Infoi mation
4. Assistant Treasurer Information
Full Name 1- P, Aq rs ,-
n. Full Name
. Meiling Address(include,City, State, and Tip Code) -
b. Malang Address (include :City State and Zip Code) _
svo f M /i &,Aj A- LRT
DVAe/hv 7.12451L. A/c- 2?07
. Phone Number .; , d. Email.Address ;, ,; - -
c. Phone Number d. Email Address
76Y-1'77.37
Send re ort notices by iemail .i Yes No > 'Q
Email copy of report notices
5. Custodian of Books Information (Keeper of Records
6. Account Information (incl. CRO -3500)
...Full Name - • - . , '.. , - . ..}
a. Financial Institution Foil Name
.Mailing Address (include City, State, and .Code)
�Zip
.Sam / Mi}GoUA- lel-..
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c. Phone Number " :�
d. EmaitAddresa
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b. Aceeu t'Code: " '
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`70 -5-77-M
t2O MV Cts,
erI4? 1
CA P r - 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 fiords are commingled with prohibited or other non -disclosed funds. I further certify that
this report is comp ete, true and co ctr
(714z3
Printed Name of Treasurer Signature of Appointed Trcasarer 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 o the penalties in Article 22A of Chapter
163 of the NC General Statutes.
76 Z3
PriatedName of Candidate Signature of Candidate Date
CRO -2100A NC State Board of Elections November 2019
=l NORTH CAROLINA
STATE BOARD OF ELECTIONS
CeMcation of Financial Account Information
This Certification is used to report confidential bank account information for all financial accounts
established by the committee and most accompany the Statement of OrganiraBon Forst.
FILED BY: ((��
Committee Name: =C bo I
Treasurer Name:
Treasurer Address: A4h,SAlr4 LAA/4;- ^� r—
(include city. state. @ zip) �Tl Q eA*J 17C,4L- e N �— 2PO 77
Treasurer Phone: gaff ^S77-IF%6Q
1 certify that the information provided below is tris and accuras. I am providing all account information for the above
named Committee. These accuum numbers include all bank accounts utilized, credit card accounts, mursy marks or
savings accounts or my 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. T1s militiamen
provided is only used for the purlwises of an audit or investigation or as mquired by a court of competent jurisdiction.
Each treasurer (or candidatel must desiernme below an account code (any number or Mier or combination of
numbers and letters) by which to refer to the account number on renals. If an account number is used as the "account
code." confidentiality of the account number is limurned to have been waived.
The treasurer shall maintain all moneys of the political committee in a hank account or bank accounts used exclusively by
the political committee and shall not commingle those funds with any other moneys.
r h=of curet ifolalm booldiao Add. A.ml Number Account Cad
W s 64& OiJo k wrAt
By sign s smtement I authorize agents of the State Board of Elec srm to inspect uounls provided.
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Due S�a� �gmNrt d('aodidmt ar Tmmuv
For Candwide Committees Only
❑ In lieu of providing account information. I certify But anis committee will not raise my money our spend my moray
except that which is the candidate's personal funds. I furthermore understand that an audit or investigation could
warrant the probe of my personal hank 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.
IN. Slmad sianowe d Csdidoe w Trpmm
CRO -3500 Centfsarron of Financial Account fnfonnarion