Klaus,Heather_2023-7-7-CommitteeFormsStatement of Organization - Candidate Committee .IllIIs.ththis statement:
New ❑ Amended
Use this form to create a new or update an existing candidate committee.
This form must be accompanied b% form CRO -3500. An amended torn[ is required fir each new election Neat.
1, Committee Information
. Name of Committee
d. ID Number
E kct H4to+keiraus
m RD
b. Mailin Address include City, State and Zip Code)
e. Date Organized
3 CLkeotd Lane
43
. Committee Websile (Optional)
E Phone Number
C)vo
Wiww, IrtdlaA4yn ckav ,Low_
2. Candidate Information
. Full Name
e. Party Affiliation
Hea+her Lee Klaus
bi
I ,
W. Mailing Address (include City. State, and Zip Code)
t. Office ought
31 00 &Ackhead /V..
IhdI , � al � Town cola
. Phone Number
I d. Email Address
g, Next Election Year
1h. Jurisdiction
w Woo -b/
aZDoZ3
❑ Email co v of report notices
. Treasurer Information
d. Assistant Treasurer Information
. Full Name
be kda.4js
a. Full Name
b. Mailing Address (include City, State, and Zip Code)
b. Mailing Address (include City, State and Zip Code)
3008 &dc kad /ane
. Phone Number d. Email Address
e. Phone Number
Id. Email Address
90` 143 kilo
-IW elec4,eoaWF
Send re tort notices by email LI I es No
U Email co tN of report notices
5. Custodian of Books Information (Keeper of Records
Account Information (hurl: (70-3500)
. Full 'Name
a+Financial Institution Fall Name
b. Mailing address (include City, State, and Zip Code)
I V a—
JUL 0 7 Zi,23
c. Phone Number
d. Email Address
Is. Account Code
Ic. Type Union Co. Board of Flections
❑ Email copy of report notices
1 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.
8�+ .r I , KIaaS
r�u-o- 3
Printed Name of Treasurer I
Signature of Appointed Iicavu it Date
I certify that the information above is correct, and 1, as the
candidate, appoint said treasurcr 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.
L•
y
T6x
Printed Name of Candidate
Signature ofCandidate ate
CRO -1100A NC Sute hoard of Elections Novemher 2019
61
• f 0 • K A
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 riled.
FILED BY:
Committee Name: fleck NeA+bey- 04-x5
Treasurer Name: aea-!"he+- L / Kla-tS _
Treasurer Address: JW S exAc".oa d /•v RECEIVED
(include city, state, & zip) lAdlQ n '1E i / NC 4-6-o 3 9 3111 0 7 70-23
Elections
Treasurer Phone: !JDA{ 02610 "(p / 9 3
Check One:
✓1 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. 163-278.1 OA. 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.
1 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. 1 further agree to file all future �/
reports required.
Qx"1 q/4OR3 �•Ca�
Date Signed Signature r
CRO -3600 Certification of Threshold
(61
NORTH CAROLINA
STATE BOARD OF ELECTIONS
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:
Committee Name: C lec-� Recamoe r k IaAA j
Treasurer Name: Hek+6&- L. 4gmis
Treasurer Address: 3(00 A 6uckle&d /41' _ C e 1\ / Ep
(include city, state, &zip) I ttin JI -at /. ,✓e -86--9
Treasurer Phone: W ao0 - (a / 93 JUL 0 (NLa
I certify that the information provided below is true and accurate. I am providing all account ior 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 desienate 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.
Tvpe of account Financial Institution Address
Account Number Account Code
J ram a l fiN#
- T ,1-
D odm
/.,dry 9u24
By signing this statement, I authorize agents of the State Board of Electi ns o nspec all accounts provided.
/'i` J.73!!aa
Dano Signed Signa -M& ofta didate or Treasurer
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. 1 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
CRD -3500 Certification of Financial Account Information
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 riled.
Candidate Name: NQn+hey- bo e, k laws
Committee Name: OP-G"f Ht a+ tr Kloms
Treasurer Name: %bbajhev L . Oat, s
If Candidate is own treasurer, designate an agent to carry out designations: RECEIVE D
Committee ID
Level Registered: [State] [County] If county, specify: n . GO. 4,,..F
I, ll ea eK C - IC4yJ' , hereby direct that in the event of my death or incapacity al l
(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 Entity
(Select from ¢163-278.)68(a))
�uvn;A)n'- jf7C
2.
3.
Plan for Disbursement (eg_Amount or %)
/00%
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. v /
Signature of Candidate:
Date: q-
CRO -3900 Candidate Designation of Committee Funds