Pressley,Kevin_2017-Committee-formsAmendment
Statement of Organization - Candidate Committee ❑ Yes ❑ No
Use this form to create a new or update an existing candidate committee.
This form must be accompanied by forms CRO -3100 and CRO -3500 (when amending, only re -submit if applicable)
1. Committee Information
a. Full Name
c. ID Number
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b. ailing Address (include City, State and Zip Code)
d. Date organized
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e. Phone Number
2. Candidate Information ❑ Candidate's Primary Committee
a. Full Name 1 11
e. Candidate ID Number
f. Party Affiliation
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b.MailingAddress (include City, State, and Zip Code)
g. Office Sought
c. Phone
dl Address
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It. Next Election Year
I. Jurisdiction
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3. Treasurer Information
4. Custodian of Books Information
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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c. Phone Number I
d. Email Address
c. Phone Number
d. Email Address
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I prefer to receive my notices by email ❑ Yes ❑ No
❑ Email copy of notices
5. Assistant Treasurer Information
❑ Add
E] Remove
6. Account Information (incl. CRO -3500
❑ Add
❑ Remove
a. Full Name
a. Financial Institution Full Name
b. Mailing Address (include City, State, and Zip Code)
b. Purpose
e. Phone Number
d. Email Address
c. Account Code
d. Type
❑ Email copy of notices
CERTIFICATION
I certify that the Committee or Fund is in compliance with all applicable provisio le 22A, 22b, & 22D -22M of Chapter
163 of the NC General Statutes and that no funds are commingled with pr ' ed or othe on -disclosed funds. I further certify
that this report is complete, true and correct.
Printed Name of Signer Signature of Appointed Treasurer Date
CRO -2100A NC State Board of Elections July 2014
Kim Westbrook Strach
Executive Director
1
North Carolina
State Board of Elections
441 N Harrington Street
Raleigh, NC 27603
Certification of Treasurer
Mailing Address
PO Box 27255
Raleigh, NC 27611-7255
(919) 733-7173
This Certification is used by Candidate Committees to appoint a treasurer to the committee. This form i,
required and must accompany the Candidate's Statement of Organization
FILED BY:
Candidate Name:
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
Treasurer Phone: %atf- Y9— <1%4;r
I certify that the above information is correct, and 1, as candidate, appoint said treasurer to personally fulfill
the duties and responsibilities imposed upon the appointed treasurer and subject to the penalties and
sanctions in Subchapter V111. Regulation of Election Campaigns of Chapter 163 of the North Carolina
General Statutes.
1 understand that if the above Treasurer changes, it will be necessary to certify a new treasurer and amend
the existing Statement of Organization within 10 days of the vacancy. I further understand that the above
Treasurer is required to receive training by the State Board of Elections within three mon is
appointment according to Article 163.278.9(k). ,
Date Signed
Note: This Certification is to be filed at the Election Board where the committee's campaign reports are filed.
CRO -3100 Certification of Treasurer July 2014
a
North Carolina
State Board of Elections
441 N Harrington Street
Raleigh, NC. 2760.3
Kim Westbrook Strach 1f"t'ng Address
Executive Director PO Box 27255
Raleigh, NC 27611-7255
(919) 733-7173
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:
Treasurer Name:
Treasurer Address: 733 S S
(include city, state, & zip)
Treasurer Phone: c f
I certify that the information provided below is we 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 desisnate 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 or account Financial Institution Address Account Number Account Code
By signing this statement, I authorize agents of the State Board of Elections to inspect all accounts provided.
Date Signed
Signature of Candidate or Treasurer
FoLkandidate Committees Only
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 vestigation could
warrant the probe of any personal bank account that is being used for campaign ex�pel res.
By signing this statement, I authorize agents of the State Board of Elections Spect applicable ounts.
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Date Signal ftoMfe of Candidate or ver
CRO -3500 Certification of Financial Account Information July 2014
Kim Westbrook Strach
Executive Director
North Carolina
State Board of Elections
441 N Harrington Street
Raleigh, NC 27603
Certification of Threshold
Mailing Address
PO Box 27255
Raleigh, NC 27611-7255
(919) 733-7173
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: (or n 3s
Treasurer Name: r... / a 3 S
Treasurer Address: 'Iia S S Cc &%7- S tick i
(include city, state, & zip)
Treasurer Phone: '7(3 c(— WOE S G G 9 -
Check
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_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. 163-278.1 OA. 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.
I am 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 expenditures4at have of t
reported from the beginning of the current election cycle. I further agree to a all fu[ ports ret
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Date Signed
CRO -3600
Certification of Threshold
July 2014