Price,Todd_2019-Committee-formsStatement of Organization - Candidate Committee Is this statement:
1 13 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.
l Committee Information
a. Name of Committee
d. ID Number
nz /c ie T s ee
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b. Mailing Address (include City, State and Zip Code)
e. Date Organized
c. Committee Website (Optional)
f. Phone Number
2. Candidate Information
a. Full Name
xx AA
V.
e. ParIN %flilimimi _
Ir. Mailing Address (include City, State, and Zip Code)
f. OlTice Sough) DEC 12 2011
a,�/La�
RECEIVE
c. Phone Number
d. 'mail Address
g. Next Election Year
III. Jurisdiction
❑ Email co It of report notices
3 Treasurer Information
4. Assistant Treasurer Information
a. Full Name T
C
! . P/- / C 6
a. Full Name
b. Mailing Address (include City, State, and Zip Code)
h. Mailing Address (include City, State and Zip Code)
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.liorf rcOt'r OPC
c. Phone Number
Id. Email Address
c. Phone Number
d. Ismail Address
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Send report notices by email 0 Yes 0 No
U Email co v of re port notices
.5. Custodian of Boolcs Information (Keeper of Records
6. Account Information. (incl.. CRO -3_W1,
a. Full Name
a. Financial Institution Full Name
It. Mailing Address (include City, State, and Zip Code)
c. Phone Number
d. Email Address
b. Account Code
c.] N pe
❑ Email copy of report notices
I certify that the Committee is in compliance with all applicable provisio of Article 22A of Chapter 163 of the NC
General Statutes and that no funds are commingled with prohibited or oth non -disclosed funds. I further certify that
this report is complete, true and correct. , " /
T6n� F. I/V/� rL/�
Printed Name of Treasurer Signature A brinted Treasurer Date
I certify that the information above is correct, and I, as the candidate, appoint said treasurer to personally fulfill the
duties and responsibilities imposed upon the appointed treasurer and s ject to the penalties in Article 22A of Chanter
163 of the C Ge eral Statutes.
Qc/ 19'/
Printed Name ot'Candidate Sillffiturr of Candidate Date
CRO -2100A NC State Board of Elections November 2019
E
0
vol NORTH CAROLINA
STATE BOARD OF ELECTIONS
UNION COUNTY
CAMPAIGN FINANCE
DEC 12 2019
RECEIVED
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: %Qd j pt lC E 1Fd2 "tcy/ 2-0-,fr
Treasurer Name: ;noA, F. Qtrle -e..
Treasurer Address: 36D1K T(8 jt�ty bk-
(include city, state, & zip) M d w fldk� L 29116
Treasurer Phone: ? L ,r O'KeK
Ch_eglt/ne:
V 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.
I am withdrawing my Certification to remain at or under the $1,000 threshold. I will now be required
to file the next scheduled report for all contributions and expenditures that have of been previously
reported from the beginning of the current election cycle. I further agree to file all fu r reports required.
L /L
Date Signed 1phature
CRO -3600 Certification of Threshold
O
rii
NORTH CAROLINA
STATE BOARD OF ELECTIONS
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:
/'o ,b,6 PrI e, rot Ol,p
Treasurer Name: 7e,>,6 T• o�ez/G!�
Treasurer Address: Q �/ %/!=�!j`/I�j/ An—
(include city, state, & zip) 0� A e 2g/le
Treasurer Phone: ?0+/ 7 2-
I 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.
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.
Tvoe of account Financial Institution Address
Account Number Account Code
C Qf iL�/n
,G�
LDd �No�jga 7�j�
p
A/0 V4.
By signing this statement, I authorize agents of the State Board of Elections to m ec coun:,provided.
/ 2 /L
Date Signed signature oftw6ute dr Treasurer
For Candidate 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 or investigation could
warrant the probe of any personal bank account that is being used for campaign expgt)ditures.
By signi g this statement, I authorize agents of the State Board of Elections ec pliclible accounts.
DatefSign Si Candidate or reasurer
CRO -3500 Certification of Financial Account Information
voT NORTH CAROLINA
mr STATE BOARD OF ELECTIONS
I Certification of Financial Account Information I
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: a
�� Arl e'e Fot ,roe
Treasurer Name: T ,dtz
Treasurer Address: J O d x %/!=�l9Yl�y SPL
(include city, state, & zip) /# _ /L
Treasurer Phone: 7Oz 2 ysr lJJG
I 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 desienate 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 of account Financial Institution AddressAccount Number Account Code
T -•vig4 /''7 ii — &V
By signing this statement, I authorize agents of the State Board of Elections to in e counts provided.
Date Signed Signature of? an ' f to & Treasurer
For Candidate 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 or investigation could
warrant the probe of any personal bank account that is being used for campaign expgtrilitures.
By signipg this�statement, I authorize agents of the State Board of Electionsta*4ec/}pplictLble accounts.
or
CRO -3500 Certification of Financial Account Information
Ala tV4 ..
T -•vig4 /''7 ii — &V
By signing this statement, I authorize agents of the State Board of Elections to in e counts provided.
Date Signed Signature of? an ' f to & Treasurer
For Candidate 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 or investigation could
warrant the probe of any personal bank account that is being used for campaign expgtrilitures.
By signipg this�statement, I authorize agents of the State Board of Electionsta*4ec/}pplictLble accounts.
or
CRO -3500 Certification of Financial Account Information
VOTE
rTIT�
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 163-278.1613(a).
This Designation is tiled at the Board of Elections office where the committee's campaign reports are filed.
Candidate Name: 7d eh X7• pie C -C -
Committee Name: %O A Ply e c�
Treasurer Name: / C C4 -
If Candidate is own treasurer, designate an agent to carry out designations:
Committee ID #:
Level Registered: [State] [County] If county, specify:
I, Ar/C ve , hereby direct that in the event of my death or incapacity all
(Name of Candidate)
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 %)
(seteet from g16/3-278. 16s(o))
t.
#71, el Jacor
2.
3.
By signing this form, I certify that the foregoing entities are eligible beneficiaries under N.C.
Gen. Statute 163-278.16B(a). A copy of this fo should be maintained with the Committee
records.
Signature of Candidate:
Date: I L I L l UNION C
CAMPAIGN
DEC 12 2019
CRO -3900 Candidate Designation of Committee Funds RECEIVE
NORTH CAROLINA
STATE BOARD OF ELE
SEN 2 4 )020
Union Co. EI
Certification of Threshold —7
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: fJ
Committee Name: 76 q1/ /Pr lc� e ir0lt, �e' �/ 0 o
Treasurer Name: /dcikt- r/ -/e C
Treasurer Address: 506
(include city, state, & zip) /110 /% AV F
Treasurer Phone: ! y y (0 d T
Check One:
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.
I am withdrawing my Certification to remain at or under the $1,000 threshold. I 'Il now be required
Ie the next scheduled report for all contributions and expenditures that Id
n t been previously
reported from the beginning of the current election cycle. I further agree to fil ur reports required.
110 t ZOLo
Date Signed Nre
CRO -3600
Certification of Threshold
aNORTH CAROLINA
STATE BOARD OF ELECTIONS
Certification to Close Committee
This Certification is used to express the intent to close the committee after all funds have been properly
disbursed.
This Certification is riled at the Board of Elections office where the committee's campaign reports
are filed.
FILED BY:
Committee Name: 6C// r /C C,_ �b ✓
Treasurer Name: 72) 44r lC G
Treasurer Address: d D 7-16i�!.y t M
(include city, state, & zip) Aon Xde /t C ,/—j /! d
Treasurer Phone: -W tk r f— m�2�
I certify that the above mentioned Committee intends to close and cease existence. Upon signing this
certification, I declare that all funds have been distributed and reported (if required). In addition, no
contributions will be accepted or disbursements made after the "Final Report" is filed or this form is
signed. If the Committee at any future time intends to accept or spend funds in support or opposition of
any candidate or ballot issue, a new political committee must be formed and registered with the Board of
Elections before such activities may commence.
Committees that have filed under the $1,000 threshold will only be required to sign this Certification. No
"Final Report" will be required for committees meeting this criterion. Any Committee that did not file
under the $1,000 threshold must submit a "Final Report" with this Certificatipp. This report must have a
zero balance with no outstanding loans or debts. i
ll S'd oi-d
Date Signed ION COUNTY Signature
— MPAIGN FINANCE
NOV 0 5 2020
RECEIVED
CRO -3400
Certification to Close Committee