Palacios,Maria_2023-Amended-StmtOrgStatement of Organization - Candidate Committee Is this statement:
New Q 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 Commit Ice
d. 1 n N umhcr
COMMITTEE TO ELECT MARIA PALACIOS
. Mailing Address (include City, State and Zip Code) _
e. Date Organized _
3903 GARRISON CT, MONROE, NC 28110
12/28/2021
c. Committee website (Optional)
L Phone Number
(704)207-5519
2. Candidate Information
a. Full Name _
e. Party Affiliation
MARIA PALACIOS
DEMOCRATIC
. Mailing Address (include City, State, and Zip Code)
E Office Sought
3903 GARRISON CT
MONROE, NC 28110
BOARD OF EDUCATION DISTRICT 3
. Phone Number
d. Email Address
g. Next Election Yearh.
Jurisdiction
(704) 207-5519
maria4ucps@gmail.com
2028
❑ Email copy of report notices
T. Treasurer Information
4. Assistant Treasurer Information
a. Full Name
a. Full Nunw
MARIA PALACIOS
. Mailing Address (include City, State, and _Zip Code)
b. Mailing Address (include City, Stale and Zip Code)
3903 GARRISON CT
MONROE, NC 28110
. Phone Number
d. Email Address
C. Phone Number
d. Email Address
(704) 207-5519
maria4ucps@gmail.com
Send report notices by email El Yes ❑ Nofhniil
eo y of report notices
5. Custodian of Books Information (Keeper of Records
6. Account Information (incl. CRO -3500)
a. Full Name
a. Financial. lustif4a" Faa'Name
MARIA PALACIOS
FIRST CITIZENS 8ANR
It. Mailing Address (include City, State, and Zip Code)
2 2f3
3903 GARRISON CT
juL UU
MONROE, NC 28110
. Phone Number
d. Email Address
b. Acc c"Type
(704)207-5519
801 CHECKING
[3 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. I further certify that
this report is complete, true and correct.
lC yaink �{,\tl�c (Q9 ���.��
,f � 7/27/2023
Printed Name of Treasurer
Signature of 4pointed 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 and subject to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
Malrir� Qnlcrrtc3�
Printed Name of Candidate
Signature of andida[e D e
CRU -2f 00A NC State Board of Elections November 2019