Price,Todd_2024-Statement-Org-amendedStatement of Organization - Candidate Committee I Is this statVment:
❑ Ne" � 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
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d. ID Number
b. Meiling Address (include City, State sad Zip Code)
e. Date Organized
300V 119onV11DF J e
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c. Committee Website (Opdouaq
L Phone Number
2. Candidate Information
a. Full Name
e. Party Affllation
b. Melling Address (include City, State, and Zip Code)
f. Office Sought
300 ri�F�y a�
In 0/v,42 4)4!5,7 Ne - ?:y
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. Phone Number d. Emieall Address
g. Next Election Year
Ill. Jurisdiction
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Email co of re ort notices
❑report
3. Treasurer Information
4. Assistant Treasurer Information
. Full Name
r
a. Full Name
. Meiling Address (include City, Shte, and Zip Code)
b. Melling Address (include City, State and Tip Code)
36c,l(e T/�L
API d1t /104!57-- i1 C 70 / d
Phone Number
Id. E/man Address
c. Phone Number
Id. Email Address
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jM1,POteOep*Dl!4/1�l• r
Send report notices by email LJ Yes L1 No
LJ Email cop of report not
5. Custodian of Books Information (Keeper of Records
6. Account In ormation (eels!. CRO -3500)
a. Full Name
a. Financial Institution Full Name
b. Mailing Address (include City, State, and Zip Code)
c. Phone Number d Email Address
b. Account Cade
c Type
❑ 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 r er non -disclosed funds. I further certify that
this report is cum tetetru
, e and correct. �XL
Printed Name of Treasurer Signature o ppointed 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 Aject to the penalties in Article 22A of Chapter
I Statutes.
163 of theh NC�G/pn aSt
Printed Name of Candidate St tore of Candidate Date
CRO -2100A NC State Board of Elections November 2019
voTEi NORTH CAROLINA
STATE BOARD OF ELECTIONS
Candidate Desianation 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 riled at the Board of Elections office where the committee's campaign reports are filed.
�1 -/
Candidate Name: i D a �
Committee Name:
Treasurer Name:
f 6/I„l - PRI L/&=
o'a« 1�nle�e
If Candidate is own treasurer, designate an agent to carry out designations:
Committee ID #:
Level Registered: [State] [County] If county, specify:
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
(Select fpm §163-278.16B(a))
2.
3
Plan for Disbursement (eiz. Amount or %)
'ed 7D
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 form should be mained with the Committee
records. r .
Signature of Candidate:
Date:
/z
CRO -3900 Candidate Designation of Committee Funds