James,Angelia_2023-SOStatement of Organization - Candidate Committee I this statement:
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 fort is required for each new election year.
1. Committee : : rmiltion
. Name of Committee
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d. ID Number
PUM&S3
. M Address (Io ode City, State and Zip Code)
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e. Date Osgashmd
9-01 1-7,7)
C. Committee Website (Optiona)
E Phone Number
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2. Candidate Information
. Full Name
Ayx2l'io, -YAme-'
e. Party Affiliation
. Mailing Address (include City, State, and Zip Code)
E Office Sought
QO 63K 15'01(0 t Alonrae nt zS It 1
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c. Phone Number
d. mallAddress
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g. Next Election Year
b. Jurisdiction
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2 6 2 3
❑ Email co of report notices
. Treasurer Information
4. Assistant Treasurer information
. Full Name
a. Full Name
. Mailing Address (Include City, State, and Zip Code)
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It. Mailing Address (include City, State and Zip Code)
Phoae Number d. Email Address
c. Phone Number
d. Email Address
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Send report notices by email ❑ 1'es ❑ No
Email copy of re ort notices
. Custodian of Books Information (Keeper of Records
6. Account flfoi'msfion - (lire(. CRO-350o�
. Full NaTm
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a. Financial Institution Fall Name
. Mailing Address( d and Zip Code)
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. Phone Norther Id. Email Address
It. Account Code
Type
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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. 1 further certify that
this report is complete, true and correct
-7-
Printed Name of Treasurer gnature of Ap ointed Treasurer Date
I certify that the information above is correct, and I, as the candidate, appoint said treasurer to personally fulfill the
of es and responsibilities imposed upon the appointed treasurer and subject to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
fn9; ti'l � A-e%..eJ '?- *1-7'2-3
IPrinted Name of Candidate 'Signtilure of Candidate Date
CRO -2100A NC State Board of Elections November 2019