Mills,Parker_2024-Amended-Stmt-OrgStatement of Organization - Candidate Committee Is 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 form is required for each new election year.
1. Committee Information
a. Name of Committee
d. ID Number
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W Mailing Address (include City, State and Zip Code)
e. Date Organized
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. Committee Website (Optional)
L Phone Number
2. Candidate information
a. Full Name
e. Party Affiliation
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. Mailing Address (include City, State, and Zip Code)
E Office Sought
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. Phone Number I d. Email Address
g. Neat Election Year
h. Jurisdiction
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❑ Email copy of re port notices
3. Treasurer Information
4. Assistant Treasurer Informs on -""-
a. Full Name
a. Full Name
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b. Mailing Address (include City, State, and Zip Code)
b. Mailing Address (include City, State and Zip Code)
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M,bew0c NC X6110
c. Phone Number
d. Email Address
r. Phone Number
d. Email Address
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Send report notices by email ❑ Yes ONo
Email copy of re ort notices
5. Custodian of Books Information (Keeper of Records
6. Account Information (met. CRO -3500)
a. Full Name
a. Financial Institution Full Name
R.Oocy� M. NWore
b. Mailing Address (include City, State, and Zip Code)
1<00 Dlucerson 6Ivd .
Mollru-( N C' a� 10
DEC 12 2023
. Phone Number
Id. Email Address
b. Account Code
c. Type Union Co. Board Electons—
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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 prohibited or other non -disclosed funds. I further certify that
this report is complete, true and correct. `/wj43
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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
duties and responsibilities imposed upon the appointed treasurer ubject to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
A W1Cr_r Mills Sty 1
Printed Name of Candidate r reandidate Date
CRO -2100A NC State Board of Electimis November 2019