Simpson,Cameron_2024-CommitteeStatement of Organization - Candidate Committee Ls/his 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. Committee Information
. N e of Committee
4944U
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aMd U,4 ell,
d. ID Number _
S
Is. Mailing Address (include City, to Apd Zip_C de)
1o`I �7d�d or 2�c��
e. Date Org
6 Y �ZY
. Committee Website (OptionaN
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f. Phone N mher
7v7. 6Ze- (w
. Candidate Information
a. Full Full Name _
e. Party Affiliation
. Mailing Address (include City, State, and Zip Code)
7loy at
E Office Sought
<S00 '6
. Phone Number
d. Email Address
g, Next Election Year
h. Jurisdiction
7(-?Y6ZZ6
6 `�C4 `e- A>',.�
❑ Email copy of report notices
3. Treasurer Information
4. Assistant Treasurer Information
a. F 1 Name
a. Full Name
. Mailing Address (include City, State, Md Zip Code)
b. Mailing Address (include City, State and Zip Code)
71o(i umy
Ile'vidoe, A16 601'/o
. Phone Number
76Y6ZZ6016
d. Email Address
c Phone Number
d. Email Address
cow -
Send report notices by email Yes No
Email copy of report notices
.-Custodian of Books Information (Keeper of Records
6. Account Information (ine[ CRO -3500)
. Full Name
a. Financial Institution Full Name
REcLIVED
b. Mailing Address (include City, State, and Zip Code)
jum
UNION COUNTY
. Phone Number Id. Email Address
b. Account Code
Ic. Type BOARD
❑ 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
thisr ort is complete, true and correct.
i�Iwo„i �A6 ly z
Printed Name of Treasurer Signature of A ed Treasurer Dfite
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 tre urer and subject to the penalties in Article 22A of Chapter
163 =Elbe NC Generales.
C/�:WU.Vttn fdr.
Printed Name of Candidate Signature - didate to
CRO -2100A NC State Board of Elections November 2019
�) NORTH CAROLINA
STATE BOARD OF ELECTIONS
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 filled at the Board of Elections office where the committee's campaign reports
are filed.
FILED BY: /�
Committee Name: I`StW4CV011 S%
MN
NORTH CAROLINA
STATE BOARD OF ELECTIONS
Confidential
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: ` Q
i
Committee Name: otic cJ• a�> >\ o c"
Treasurer Name: vte(ia�
Treasurer Address:
(include city, state, & zip) CQ
Treasurer Phone: %O y 6Z Z- 6o, !M
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 funds with any other moneys.
Type of account Financial Institution Address AVIFiMNUED Account Code
JuN
amom
By signing this statement, l authorize agents of the State Board of Elections to i%gpAV0Wcbhh&f i Mcd.
Date Signed Signature of Candidate or Treasurer
For Candidate Committees Only
1K In lieu of providing account information, l 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 signinjg this statement, I authorize agents of the State Board of EI as to inspe cable accounts.
Date igned Signature ofC dida or Treasurer
CRO-3500 CerlifcalionofFbtancia(Account lnfomialion