Holtey,Elizabeth_2023-Committee-formsStatement of Organization - Candidate Committee Is this statement:
I 1K Men, ❑ 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
. Name of Committee _
c�z Jac o�Te
d. ID Number
. Mauling Address (Include City, State and Zip Code)
e. Date Organ@ed
56/7
AC -W10
. Committee Website (Optional)
it Phase Number
2. Candidate Information
a. Full Same
L12�4t3EjL( 4269LE-1/04-7-EY
e. Party Affiliation
/NDE.P(-Wd9-AIT
. Mailing Address (include City, State, and Zip Code)
6"0/7 DODVIC-A) lAoiE
W0OlN6 roN NC ,Z8/D�f
I. Office Sought
M•¢y02 OF 6t1E0dfNl�TdV
. Phone Number
9)7 -53t-
d. Email Address
f/ol rc\/F419M/YOR0/C
O L•
g. Next Election Year h. Jurisdiction
Email copy of report notices
3. Treasurer Information
4. Assistant Treasurer IM
. Futi Name
SOME -48DVE CANDM Ot /N16i2H4r
a. Full Name
JUL 31 2023
Malting Address (Include City, State, and Zip Code)
b. Mailing Addie n (inclnde , State and Zip Cade)
_
UnionCO- e(
. Phone Number
Id. Email Address
c. Phone Number
d. Email Address
Send report notices by email MNes No
Email copy of report notices
. Custodian of Books Information (Keeper of Records
6. Account Informatiiin /bict CRO -7500) -
. Full Name
WSEE A&K CAND1pA-7r- lAlatlFTIM
a. Financial Institution Full Name
. Mailing Address (include City, State, and Zip Code)
. Phone Number
d. EmailAddress
b. Account Code
c. Type
VLEmail 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.
Printed Name of Treasurer Signature of Appointed Treasurer Date
I certify that the information above is correct, and 1, as the candidate, appoint said treasurer to personally fulfill the
uties and responsibilities imposed upon the appointed treasurer and subject to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
�G/2i48E',T// CDBLL--gotM � -lle
Printed Name of Candidate Signa Ca
of ndidate Date
CRD -2100A NC State Board of Elections November 2019
NORTH CAROLINA
STATE BOARD OF ELEC
Certification of Threshold
JUL 31 2023
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:
Check One:
CGIZ4 /'STN j�6LTEi
NCD61&6 "IV /VC WF107
31—ZI4133
X I certify that this committee intends to neither receive nor expend more than $1,000 during the current
e ection 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 during 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 futurereportsrequired.
2023
Lz
Date Signed Sign
CRO -3600 Cerliiftation of Threshold
NORTH CAROLINA
STATE BOARD
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: _EL12r4(�rc7tl COCZL6-LIOLTEy
Treasurer Address: 50/1/ "oDV I C A J LAVE
(include city, state, & zip)
Treasurer Phone: C9/'l) 53/- 0133
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 (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.
Type of account Financial Institution Address
Account Number Account Code
By signing this statement, I authorize agents of the State Board of Elections toiWpect all accounts provided.
Date Signed Si atop of Candidate or Tr uredas r
For Candidate Committees Only
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 Signature of Candidate or Treasurer
CRO -3500 Certification of Financial Acctomnt Information
gTPE NORTH CAROLINA
STATE BOARD OF ELE
rOOMM
JUL 31 2023
Candidate
of Committee
This form is used by candidate committees only and allows the candidate to designate in the event of their death,
how the committee's fimds are to be disbursed using the eight allowable methods outlined in 163-278.16B(a).
This Designation is Sled at the Board of Elections office where the committee's campaign reports are filed.
Candidate Name:
Committee Name:
Treasurer Name:
,1IZ+`1'BEja COQC4C-!'iDtT-Ey
If Candidate is own treasurer, designate an agent to carry out designations:
Committee ID #:
Level Registered: [State] (County] If county, specify: UA110At
I, kl./2a4ETi I /101-TE.Y, 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 Entitv
(Select jhnn §163-27R16B(a))
I. THE PU,6 OUEEN
2.
3.
Plan for Disbursement (ee. Amount or %)
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.
Signature of Candidate:
Date:
CRO -3900 Candidate Designation of Committee Funds