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Griffin,Wendy_2023-Committee-formsStatement of Organization - Candidate Committee Is t statement: Ne" ❑ Amended Use this form to create a new or update an existing candidate committee. This form must he accompanied by fount CRO -3500. At) amended form is required for each new election year. 1. Committee Information . Name of Committee d. ID Number D. Malling Address (12clucle City, State and Zip Code) e. Date organized o —NZ::U 1Ga8►lo 1ac>a3 . Committee Website(Opnimap LP one Number 2. Candidate Information -- - a. Full Name e. Partv Affiliation �^ . Mailing Address (in Nude City, State, and Zip Code) f. office Sou ht V t fel(—;,18*11 1Lc— MW6%S Lv%« . Phone Number d. Emall Address g. Next Election Year Its. Jmisdicams CJAIL 104— — _mail copy of report notice 3. Treasurer Information 4. Assistant Treasurer Information . Full Name a. Fail Name ASe fir;JAd Tarre r 6radbrn . Mailtug Address (IncludehCode) b. Mailing Address (include CI 3301 ZCbUJ0n I:ZS ..,I n ' � Monro NC 2TI10 'I` ` J `_`"s . Phone Number Id. Emall Address c. Phone Number Id. E - &4ft. Board of Elections �s- 6bh�rc 90 cul•"M - Send report notices by email esNo U Email coE of re ort notices 5. Custodian of Books Information (Keeper of Records 6. teuu o ' o ` rrl CRO -3500) a. Full Name a. Financial Institution Full Name b. Mailing Address (include City, State, and Zip Code) c. Phone Number d. Email Address b. Account Code c. Type ❑ 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. Bre dant IurnU Signature Appointed Treasurer rimed Name of Treasurer 4F of ate I certify that the information above is correct, and 1, as the candidate, appoint saV treasurer to personally fulfill the duties and responsibilities imposed upon the appointed treasurer and subject a penalties in Article 22A of Chapter 163 of the NC General Statutes. Oe Praked Name of Candidate Signa a of date Dale CRO -2100A NC State Board of Elections November 2019 v© NORTH CAROLINA UM 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: f / —� n Committee Name: We-n T Gr;�,'� ;r Unij)rJV;JI , IDwn CSU j l Treasurer Name: Treasurer Address: 3301 (include city, state, & zip) M e o rm NC. 21110 Treasurer Phone: W - Sag •� a `' , Wz I certify that the information provided below is true and accurate. I am providing all acAiflibfo"f{4&' 61&ove 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 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. NORTH CAROLINA STATE BOARD OF ELECTIONS Certification of Threshold This Certification is used to declare or withdraw a committee's intent to raise or spend $1,000 or less in the current election cycle. This Certification is only valid for political party committees and candidates for a county office, municipal office, local school board office, soil & water conservation district board of supervisors, or sanitary district board. This Certification is filed at the Board of Elections office where the committee's campaign reports are filed. FILED BY: Committee Name: Treasurer Name: Treasurer Address: (include city, state, & zip) Treasurer Phone: 53 Rn — 3 a R — tI l Chec ne: I certify that this committee intends to neither receive nor expend more than $1,000 during the current election cycle under the procedures set forth in G.S. 163-278.10A. This certification will remain in effect until the end of the election cycle for this committee. If this committee exceeds $1,000 in contributions or expenditures dining this election cycle, I understand that I must immediately notify the appropriate board of elections and file required campaign finance reports. THIS DECLARATION CAN ONLY BE MADE AT THE BEGINNING OF AN ELECTION CYCLE. I am withdrawing my Certification to remain at or under the $1,000 threshold. I will now be required to file the next scheduled report for all contributions and expenditures that have not been previously reported from the beginning of the current election cycle. I further agree to file all fu eports required. ' D'le ig "n signsetim CRO -3600 Certification of Threshold RECEIVED AUG 10 2023 Union Co D'oard of EIS , rr, VOTE NORTH CAROLINA STATE BOARD OF ELECTIONS 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: Committee Name: Treasurer Name: c If Candidate is own treasurer, designate an agent to carry out designations: Committee ID M Level Registered: [State] [County] If county, specify: j_, le, y\4 ' jr_— r. hereby direct that in the event of my death or incapacity all (Name o 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 (Seleec-t- from—§163-27& 168(x)) 1• v-. AA 1 cAV-YItT �OE7�'Vl 2. tj Plan for Disbursement (eg. Amount or %) By signing this form, I certify that the foregoing entities are Gen. Statute 163-278.16B(a). A copy of this form should records. I / /�— / Signature of Candidate: Date: CRO -3900 beneficiaries under N.C. tied with the Committee Candidate Designation of Committee Funds E V AUG 10 2u23 Union co. Board of Elections