Mills,Parker_2023-Committee-formsStatement of Organization - Candidate Committee Is this statement:
❑ NOW ❑ 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
d. ID Number
COMAIrF(C % CLC -CT
P*?xCR iLLs
STM 1V to
. Mama{ Address (Include City, State` and ZAp Code)
e. Date Organized
%Ill �ALLAr�U J'A ti
. Committee Website (Optional)
r. Phone Number
2. Candidate Information
. Full Name
e. Par�ARlianon
ARaOL� 94AKtR MtLl,S Tit
. Mailing Address (include City, State, and Zip Code)
E office Sought
III ! MA LLARI ",V) W 6— AP,
MpA)ROC /VC— 1-8'110
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. Phone Number
d. Email Address
. Next Election Year
h. Jurisdiction
Z
❑ Email copy of re port notices
3. Treasurer Information
4. Assistant Treasurer Information
. Fun Name
a. Full Name
Ind Br R i M 00 /Zc
. Mailing Address (include City, Steteand Zip Code)
b. Mailing address (include City, State and Zip Code)
_
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. Phone Number Id. Email Address
c. Phone Number
d. Email Address
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y
Send report notices b email Yes Nn
Email con of report notices
5. Custodian of Books Information (Keeper of Records
6. Account Information Anel. CR43500)
. Full Name
a. Financial Institution Full Name
. Mailing Address (include City, Sf�te aad Pip Cade)
froo 7J.i./41LSodJ NI-✓, —
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. Phone Number 10.
'
Email Address
b. Account Code UHIU
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M: a5_ w
❑ 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%jhibited
m other non -disclosed funds. 1 further certify that
this report is complete, true and correct ,
f2d6(rT/l?• /1'1oor�- ��i��----
�/y v3
Printed Name of Treasurer
Signature of Appointed Treasurer Date
1 certify that the information above is correct, and], as the
capa point said treasurer to personally fulfill the
duties and responsibilities imposed upon the appointed [res
rer and su 'ect to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
Printed Name of Candidate
signature Candidate Date
CRO -2100A NC State Board of Electicilis November 2019
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: co Abh f Tf r F To a EC % PARK.(=/(
Treasurer Name: A S 4 /Q j /i1_ /y 00 /U --
Treasurer Address: /1D0 b(CKt,?SOA) 84o3
(include city, state, & zip) /11 0A1 R 1 ( A/ C X Yf1 p
Treasurer Phone: '%o y — 96of' ? %f
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
Cht r,k1A
SKS -C I Tt N
1H f& —I �E 0rJ Sly
By sig 'ng this statement, l authorize agents of the State Boardp f4lection to inspect all accounts provided.
Date Signed Signature of Candidate or Treaaorer
For Candidate Committees Only
J 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
tha ng used for campaign expenditures.
By signing this statement, 1 aut}ref,c, ge o
+ Q�ftt� n oard of Elections to inspect applicable accounts.
Date Signed tVj 1 + 2W Signatm of Candidate or Treasurer
U.
on Co. bpasu U
CRO -3500 Certification of Financial Account Information
NORTH CAROLINA
STATE BOARD OF ELECTIONS
Candidate Desianation 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: A111V OL -D Q/4/tl<t Z M aL S ?,2
Committee Name: Co#'IMI 7b (`LACI PXkKt 2
Treasurer Name: /? o a rR i A, lh oog
If Candidate is own treasurer, designate an agent to carry out designations:
Committee ID #: 3-f/It4 J_ V
Level Registered: [State] [County] If county, specify: (//✓i �A1 Cd UN �V Al, L
I'AP,VUL-) WArt /11LCS Tereby 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 marine[ as permitted by N.C. Gen. Stat. 163-278.16B(a).
Name of Entity
(Select fe §163-278.16B(o))
110 + r ?-DW,✓ ly v S
2.
3.
Plan for Disbursement (eg. Amount or %)
By signing this form, I certify that the foregoing entities are eligible beneficiaries under N.C.
Gen. Statute 163-278.16B(a). Acop orm should be maintained with the Committee
records.
Signature of Candidate: —IV
Date:
'A 19 2023
CRO -3900
Un'.on Co Earl ol Elections
Candidate Designation of Committee Funds