Pollino,Joe_2021-Committee-formsStatement of Organization - Candidate Committee I this statement:
Nen' ❑ 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. In Number
b. Mailing Address (include City, State and Zip Code) e. Date Organized
c. Committee Website (Optional) E Phone Number
70f
2. Candidate Information
a. Full Na//me
e. Party Affiliation
b. Mailing Address (include City, State, and Zip Code)
f. Office Sought
13 �1art- e AX.
as
NC --"'c5/
1401VO4rN�r.,�
c. Phone Number
d. Bluail Address
g. Next Election Year
h. Jurisdiction
❑ Email copy of report notices
3. Treasurer Information
4. Assistant Treasurer Information
a. Full Name
a. Full Name
Al/f'W 10
b. Mailing Address (include City, State, and Zip Code)
b. Mailing Address (include City, State and Zip Code)
/coo c7;
/r/ V,,,j NC f '/ 73
c. Phone Number
Id. Email
c. Phone Number
d. Email A ddress
i, 705 -, y"J
®Address
/�+ k'I,JL �e ��n^�t r�L'
t,
Send report notices by email ja Yes ❑ No
Email copy of report notices
5. Custodian of Books Information (Keeper of Records
6. Account Information fncl. CRO -3500)
a. Full Name
a. Financial Institution Full Name
; / A✓f /iE
RECEIVED
Mailing Address (include City, State, and Zip Code)
21 ?_021
/000 `' ` �A `JUL
1000 ✓l' -j ovC 070/'73
c. Phone Number
Id. Ema I Address
b. Account Code
c. TyWiofl Co. board 01 H0.011059--
°e on705-0
705- -0S
Lwc/%@ rtw -1se
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, hue and correct.
Printed ame of Treasurer Signatu of Appointed Treasurer Date
I certify that the information above is correct, and I, as the candidate, a p 'nt said treasurer to personally fulfill the
duties and responsibilities imposed upon the appointed treasurer an ct to allies in le 22A of Chapter
163 of the NC General Statutes
.�/(T��Ojr E'r /"oft.."+� u ✓? %�/� �/
Printed Name of Candidate Signature of Candidate Dale
CRO -2100,E NC StatA Board of Elections r November 2019
aNORTH CAROLINA
STATE BOARD OF ELECTIONS
Confidential
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: �� "^� � YL,) �� f *1I cT ✓yF //:No
Treasurer Name:
Treasurer Address: C7',
(include city, state, & zip) /%/ht ✓/,V ^✓L a fj / 7 3
i
Treasurer Phone: 7yyS 20 — 04105—
I certify that the information provided below is hue 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. NION COUNTY
Type of account Financial Institution Address Accou bode
By signing this statement, I authorize agents of the State Board of Elections to inspect al
Date Signed Signature of Candidate or Treasurer
For Candidate Committees Onlv
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 under nd that an audit or investigation could
warrant the probe of any personal bank account that is being used for expenditu
By signing this st tement, I authorize agents of the State Board of t s ' sp icable a ounis.
is dr
Date Signed Signature of Candidate reasurer
CRO -3500 Certification ofFinancial Account Information
vo_TEl NORTH CAROLINA
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 filed.
FILED BY:
Committee Name: t iiC• A ✓R1 _ ZleCT j, 6//-_J0
Treasurer Name:
Treasurer Address: l000
(include city, state, & zip) Ae"clW /✓C X28173 UNION COUNTY
ANCF
JUL 1 b ZU21
Treasurer Phone: L?051) 705- — O yOs RFCEIV E C
VkOne:
I 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. 163-278.10A. 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.
—lam withdrawing my Certification to remain at or under the $1,000 threshold. I will now be
to file the next scheduled report for all contributions and expenditures have not be pj
reported from the beginning of the current election cycle. I further agree Il future r
7
Date Signed Signature
CRO -3600
Certification of Threshold