Simpson,Anne_2023-Committee-formsStatement of Organization - Candidate Committee Is this statement:
® 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.
1. Committeeinformation
. Name of Committee d. 1D Number
REUL
Anne M. Simpson for Commissioner
b. Mailing Address (include City, State and Zip Code)_ 20 a Date Organized_
2517 Trading Ford Drive Waxhaw, NC 28173 1 ,, July 5, 2023
c. Committee Website (optioned) f. Phone Number
704-256-4976
2. Candidate Information
a. Full Name
Anne Marie Simpson
c. Party Affiliation
REP
In. Mailing Address (include City, State, and Zip Code)
2517 Trading Ford Drive Waxhaw, NC 28173
C Office Sought
Town of Waxhaw Commissioner
c. Phone Number
d. Email Address
g. Neat Election Year
h. Jurisdiction
704-256-4976
Simpson4waxhaw@gmail.com
2023
Waxhaw NC
® Email copy of report notices
3. Treasurer Information
4. Assistant Treasurer Information
a. Full Name
Anne Marie Simpson
a. Full Name
b. Mailing Address (include City, State, and Zip Code)
2517 Trading Ford Drive Waxhaw, NC 28173
b. Mailing Address (include City, State and Zip Code)
c. Phone Number
d. Email Address
Simpson4waxhaw@gmail.com
e. Phone Number
d. Email .Address
704-256-4976
Send report notices by email U Yes M No
TI Email copy of reort notices
5. Custodian of Books Information (Keeper of Records
6. Account Information (incl. CRO -3500)
a. Full Name
Anne Marie Simpson
a. Financial Institution Fug Name
Wells Fargo
b. Mailing Address (include City, State, and Zip Code)
2517 Trading Ford Drive Waxhaw, NC 28173
c. Phone Number
Id. Email Address
N Account Code
a Type
Checking
704-256-4976
Simpson4waxhaw@gmail.com
a wxw
® Email copy of report notices
1 certify that the Committee is in compliance with all applicable provisions of Article 22A of Chapter 163 ofthe NC
General Statutes and that no funds are commingled with prohibited or other non -disclosed funds. 1 further certify that
this report is complete, true and correct.
Anne Marie Simpson -7 137 h-1
Printed Name of Treasurer Signature of Appointed Treasurer Date
I certify that the information above is correct, and I, as the candidate, appoint said treasurer to personally fulfill the
uties and responsibilities imposed upon the appointed ensurer and subject to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
Anne Marie Simpson �v �S �i 3
Printed Name of Candidate Signature of Candidate Date
CRO -2100A NC Slate Bound or Elections November 2019
MO-TTINORTH CAROLINA
,)STATE BOARD OF ELECTIONS
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�nicn Go. Board of E1z�uct — — - -
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: Anne M. Simpson for Commissioner
Treasurer Name: Anne Marie Simpson
Treasurer Address: 2517 Trading Ford Dr.
(include city, state, & zip) Waxhaw, NC 28173
Treasurer Phone: 704-256-4976
1 certify that the information provided below is true and accurate. 1 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 desitniate below an account code (any number or letter or combination of
numbers and letters) by which to refer to the account number on retorts. If an account number is used as the "account
L 11Ic." 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 Address
Checking Wells Fargo Wesley Chapel, NC
Account Number Account Code
By signing this statement, I authorize agents of the State Board of Elecj ons 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 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 At count Information
vii NORTH CAROLINA
STATE BOARD OF ELECTIONS
REC D
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Union co. 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 163-278.16B(a).
This Designation is filed at the Board of Elections office where the committee's campaign reports are filed.
Candidate Name: Anne Marie Simpson
Committee Name:
Treasurer Name:
Anne M. Simpson for Commissioner
Anne M. Simpson
If Candidate is own treasurer, designate an agent to carry out designations: Carroll Simpson
Committee ID #:
Level Registered: [State] [County] If county, specify:
I Anne Marie Simpson 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
(Sekcr from 4163-278.168(a))
I Donald J Trump for President 2024
2.
KI
Plan for Disbursement (eg. Amount or %)
100%
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 maintained with the Committee
records.
Signature of Candidate:
Date:
CRO -3900
Candidate Designation of Committee Funds