Sanders,Jennifer_2024-Stmt-OrgStatement of Organization - Candidate Committee Is this statement:
❑ New ❑ Amended
Use this form to create a new or update an existing candidate committee.
This forni must be accompanied by form CRO -3500. An amended form is required for each new election year.
1,11WImittee information
. Name of Committee
it. ID Number
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WM3B
. Mailingdress Ad (' dude City, State and Zip Code)
e. Date Organized
1 o sow r-iVe wp�-OW nc �lu 111.21; V
. Committee Website (Optional)
E Phone Number
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2. Candidate Information
a. Full Name11
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e. Party Affiliation
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. Mailing Address (include City, State, and Zip Code)
L Office Sought
. Phone Number
d. Email Address
g. Neat Election Year
1b. Jurisdiction
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❑ Email copy of report notices
3. Treasurer Information
4. Assistant' of irmation
a. Full Name
a. full Name
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b. Malting Address (include City, State, and Zip Code)
It. Mailing Addrea (include City, State and Zip Code)
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c. Phone Number
l0'�12�i-41I�
d. Emil Address
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c. Phone Number
id. Email Address
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Send report notices by email Li Yes LJ No
Email co of report notices
5. Custodian of Books Information (Keeper of Records
6. Account Infoinan tion (ince CRO -3500)
. Full Name
a. Financial Institution Full Name
t�.
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. Mailing Address (incl. d , State, and Zip Code)
JAN 1 2 2021
. Phone Number
d. d s
b. Account Code
c. Type
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❑ 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, true and correct.
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Printed Name of Treasurer Signaturr5*poinIM
Treasurer bate
I certify that the information above is correct, and 1, as the candidate, appoint said treasurer to personally fulfill the
duties and responsibilities imposed upon the appointed treasurer and subject to tl penalties in Article 22A of Chapter
163 of the NC General Statutes.
Sarje s --s
t a
Printed Name of Candidate
of Candidate Date
CRO -2100A C State Board o Icctions November 2019
PTH CAR
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: UNION COUNTY
CAMPAIGN FINANCI
Committee Name:
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
Treasurer Phone:
X30 �o�sor� Ic- RECEIVED
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 for candidate) must designate below an account code (anv 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.
of
14
Account Number Account Code
By s'going his statement, I authorize agents of the State Boar f Electro to msp ct ti . ccounts p
1 IZ Z
Dace Signed Sig"VW of Candidate or Treasurer-
For
reasurer
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 being used for campaign expenditures.
By signing this statement, I authorize agents of the State Board of Elections to inspect applicable accounts.
Date Signed Signature of Candidate or Treasurer
CRO -3500 Certification of Financial Account Information