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Smith,Thomas_2023-CommitteeFormsStatement 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 tot each new election year. 1. Committee Information . Name of Committee d. m Nanbei SmIT 144 W(Z-DZ a3--- I b. Ntailing Address (include City, State and Zip Code) e. Date Organind K4D-Fn"&u.ar4Az. C,k, YrlOTTfet-45/ ?Je, 7-8104 7-ZD-ZoZ3 . Committee Website (Optional} f. Phone Number 7a411-1 99a6- 2. Candidate Information. '• - - - - - a. Full Name e. Party Affiliation ThomA s ale I lL s �m� 4�N 1`/p OL bl )cttlJ . Mailing Address (include City, State, and Zip Code) f. Office Sought 7 1840 Y)r)gUb rA iii- C1-. ltJElDf�ngto� h&L YI'i r+" et.f, 1_Y. Z81 L14171 :qV e* # Z. . Phone Number I d. Email Address . Next Election Year It. Jurisdiction _ _ 7048778 -FJS0C-76$DQ. 1• 2-023 - U Email copy of report notices 3. Treasurer Information 4. Assistant Treasurer Information . Fall Name a. Full Name Tho)v1 A s J l.t.l l u s �� Ma Bing Address (include City, State, and Zip Code) Code) . Mailing Address (include City, State and Up Code) 1 �dr Ya I R 1c� �.-,r ebtut �rt M19-)5 OG Zg1 . Phone Number d. Email Address c. Phone Number d. Email Address 70497-799- T --s 7N-aOcz�, Send report notices by email Eaves ONo L1 Email co ofre ort notices 5. Custodian of Books Information (Keeper of Records 6. Crount Info a on (i>wrt CRO -3500 a. Full Name a. Financial Institution Full Namu -MmP,rS-T(,Jhu-% — YLr � JUL I - . Matilag Address (include City, Shte, and Zip Code) _ RECEIV _� i - - - 124 mangy tix zg ix� Phone Number ld.ErnaflAddress b. Account Code c. Type -10487-788a5 1 7"5506-Ap9be° Ccz 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. J> ^4 JT 51st A / Printed Name of Treasurer Signature of Appointed Treasurer Date 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 the penalties in Article 22A of Chapter 163 of the NC General Statutes. i Nu ✓mem-f J <'M, -H.' Printed Name of Candidate Signature of Candidate ate CRO -1100A NC State Board of Elections November 2019 PTH CAR Confidential 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: Sr)? 171t 4 1✓G6 2 3 Treasurer Name: mom A 5 —lUtUA o) S Xk`6— Treasurer Address: (include city, state, & zip) f')'lRA a,t kx- 7810 ( Treasurer Phone: —7D g&aS 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 desienate 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 Account Number Account Code d-hie6*1 ne% %kul ST I ///ra-1Wn I%'iR�7 7 r By signing this statement, I autlidg1 `e'agents 1ftj $Rate Board of Elections t ' ct 1 acco is provided. Date Signed E1V ED Signature bf Candidate or Treasurer For Candidate Committees Onl 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 tliis statement, I authorize agents of the State Board of Elections to ins pplica @ accounts. 2Z-7 4:z azq Dine Signed Signature of Candidate or Treasurer CRO -3500 Certi/kation of Financial Account Information © NORTH CAROLINA VOTE mT� STATE 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 Med. Candidate Name: -j—U&-,L5 —Z� Committee Name: SI - )121_ 41 tJ(fbZ Treasurer Name: %hom/PrS-,UA"-0-i'xtYX-- If Candidate is own treasurer, designate an' to carry out designations: /agent Committee ID M 7 3-,P4 7 '7� S/ 6 Level Registered: [State] Kunty f county, specify: I, MnS s� , ereby 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 Plan for Disbursement (ea. Amount or %) (Selen from §163-278.16B(a)) a� 1. S�.�4.1,VW t. ir�ltb�iCGnJ �Jorroirvllrllorl I&P /o c �' j,1PF,I()N FINANCE 2 3. JUL 21 2023 E By signing this form, I certify that the fore }�y�i&A/ake gible 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:�50/ Date: I CRO -3900 Candidate Designation of Committee Funds