Scaldara,Joe_2023-Committee-formsStatement of Organization - Candidate Committee Is this statement:
❑ New JW Amended
Use this form to create a new or update an existing candidate committee.
This form must be accompanied by foam CRO -3500. An amended form is required for each new election year.
1. Committee Information
a. Name of Committee
r' e,
d. ID Number
6. Mailing Address (Include City, State and Zip Code) _
_ _
e. Date Organized
c. Committee WeMite (Optional)
f. Phone Number
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2.
2. Candidate Information
a. Full Name
e. Party Affiliation
. Mailing Address (Include City, State, and Zip Code)
E office Sought
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. Phone Number
d. Emall Adtlms
g. Next Election Year
h. Jurisdiction
❑ Email ces
3. Treasuonoro
4. Assistant Treasurer Information
a. Full Name
a. Full Name
. Malang Address (include City, Staley and Zip Code)
b. Malting Addr include City, State and Zip Code)
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. Phone Number
Id. En all Addrw
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Send report notices by email 0 Yes AkNo
F.mail co c oCre port ncites
S. Custodian of Books Information (Keeper of Records
6. Account Information ` 1 CRO -3500)
a. Full Name
a. Financial Institution Full Name
b. Malling Address (Include Ciy, State, and Zip (ade)
. Phone Number
d. Email Address
b. Account Code
a 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 withpro bited or o er ndisclosed funds. I further certify that
this repp`oorrtt(iss complete. true and correct. /
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'ntedPn Name of Treasurer ignature of Appointed Treasurer Date
I certify that the information above is correct, and I, as the jandidate, appoint said treasurer to personally fulfill the
duties and responsibilities imposed upon the appointed tr urerdV su e t to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
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' led Name of Candidate Siguaturc of Candidate Date
CRO -2100A NC Suite Board of Elections November 2019
NORTH CAROLINA
STATE BOARD OF ELECTIONS
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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:
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
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Treasurer Phone: / Dpi
VOTE
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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: Colrr,vl: frAe- 7b 4-7,oaq�r Set S--4&W&-
Treasurer
--4&vwTreasurer Name: Tose- to L2!&-- Q A a „C,
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Treasurer Address: 6 <3U� rry s % C T
(include city, state, & zip) N �A. ( �G ,) g pr1 1
Treasurer Phone: 'fp c j - 92%> — Zo lz)
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 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 Akuds with any other moneys.
2023
By signing this statement, I authorize agents of the
to inspect all accounts provided.
Date Signed Signature of Candidate or Treasurer
For Candidate Committees Only
In lieu of providing account information, I certify that this committee will not mise 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 Fampaign expenditures.
By signing this statement, I authorize agents of the State Board of EItions V
p�phcable accounts.
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Date Signed tj Signature of Candidate or Treasurer
CRO -3500 Certification of Financial Account Information