Passarelli,Stephen_2023-CommitteeFormsStatement 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
an
a. Name of Committee
it. ID ?lumber
:.
(
. 3 ling?k dress clod Cify, State and Zip Code)
e. Date O suited
�m
4
.C'ummittee Welielts,(Optional)
It. Pisfine,
2. Candidate Information
a. Full . ame
e. P 'ation
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C �J f 11�/
b. Mailing Address (include City, State and Zip Code)
L O tee S ght
. out Nam6er d. Email Address
g. Iy Xt Election Year
h. JnrMdictlen
7d gid df cs�irc r Prr
,/�r�
-3
❑ Emailtices
.Treasurromn
4. Assistant Treasurer Information
a. Full Name
a. Full Name
It. ddreas (in de W.State, and Zip Code)
h. Mailing Address (Include City, State and Tip Code)
/Malan
. Phoue Number
d. Email Addrett
c. hone Number
it. Email Address
Send report notices b email Yes No
Email co v of rc art notices
. Custodian of Rooks Information (Keeper of Records
6. Account Information tbeef. CRO -3500)
. Full Name _.
a. Financial Institution Fun Name _
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J
h. Mailing Address (include Cit}, Stale, and Zip Code)
. Phoce N
a Idress
It. Account Code
1c. Type
❑ Email copy of report notices
I certify that the Committee is in compliance with all applicable pro ' ietis of Pati 22A of Chapter 163 of the NC
General Statutes and that no funds are commingled with prof
this ort is complete a correct.
- to or then non -disclose s. I further certify that
,
Printed Name of Treasurer
'/
Appoin Dat
I certify that the information above is correct, and 1, as the candi , a eas r to personally fulfill the
duties and responsibiGti impose on the appointed
a penalti s in Article 22A of Chapter
163 of e*IC Genera . tatutes.
C re
Printed Node of Candidate
LAte
CRO -2100A NC State Hoard of Elections November 2019
NORTH CAROLINA
mT� STATE BOARD OF ELECTIONS
I 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:
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
Treasurer Phone:
1 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.
Financial Institution Address Account Number Account Code
By sip thistu�tement, I authorize agents of the State
ZLQ51—C;?2
Dae Signed
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 that is�teing used for campaign expenditures.
By signing this statement, I authorize agent. of the State Board of Elections to inspect applicable accounts.
JIJ1.
Date Signed
CRD -3 500
Signature of Candidate or Treasurer
RECEIVED
Certification ofFinanciat 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 thooard of Election ffice here the commi)tge's campaign reports are filed.
Candidate Name:
Committee Name:
Treasurer Name: eel ,
If Candidate is own treasurer, designate an agent to carry out designations:
Committee m #:
Level Registered
[County] If county, specify:
hereby direct that in the event of my death or incapacity all
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 Plan for Disbursement (eg. Amount or %)
(Sel/ed mm §16633-278.16B(a))
3.
By signing this form, I certify that the for oin entities are ' 'ble beneficiaries under N.C.
Gen. Statute 163-278.16B(a). A copy this o sh93tld be tai sited 'th the Committee
records.
Signature of Candidate:
Date: Uli'liON COUNTY
;� N FINANCE
JUL 2 5 7.023
nECBVED
CRO -3906 Candidate De.signalion ofCommitlee Funds