Stone,Tracy_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.
].Committee Information
. Name of Committee
d. In Number
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MJtRg Ad _ (include City, State mWW Zip Code)
e. Date Orgadaed
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. Committee Website (Op od)
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2. Candidate Information
. Fun Name
e. Party Affiliation
Cs
. Mailing Addrao (include City, State, and Zip Code)
4420
f. Office Sought
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. Phon"INI—b�r . Email Address
g. Neat Election Year
h. Iorisdktion
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[mail co of report notices
. Treasurer Information
4. Assistant Treasurer Information
a. It Name
a. Full N me
b. Mailing Add es nclude Cl State, and Zip Code)
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ns Address (include City, State and Zip Cade)_ -
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. Phone Number d. Email Address
c. Phone Number
d. Email Address
Send re ort notices by ema Yes No
Email co v u(re ort notices
Custodian of Books Information (Keeper of Records
6. Account Information (;
. Full Name
a. Financial Institution Full Name
Ll,
b. ailing Add`re_s include
_ City, State, and Zip Code)
Elections
Union Co. Board of
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. Phone Number
Id. Email Address
. Account Code7:v)�oe,
To
—rStatutes
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13 of report notices
e Committee is in compliance with all applicable provisions of Article 22A of Chapter 163 of the NC
s and that no finds are commingled with
prohibited or other on -disclosed fiends. I further certify that
mplete, true and correct.
nted ane of Treasurert
Si f Obinted Treasurer ate
I certify that the information above is correct, and 1, as the
candidate, appoint said treasurer to personally fulfill the
s and responsibilities imposed upon the appointed treasurer and subject to Pe penalties in Article 22A of Chapter
L163'oft eneraltes.
Printed S a of Candidate
6001g:2e if Oftedate ate
CRO -2100A NC State Board L7nsNovember zOr
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 rded at the Board of Elections office where the committee's campaign reports
are riled.
FILED BY:
Committee Name:
Treasurer Name: `
Treasurer Address:
(include city, state, & zip)
Treasurer Phone:
Check One:
1 certify that this committee intends to neither receive nor expend more than $1,000 during the current
election cycle under the procedures set forth in G.S. 163-278.10A. This certification will retrain in effect
until the end of the election cycle for this committee. If this committee exceeds $1,000 in contributions or
expenditures during this election cycle, I understand that I must immediately notify the appropriate board
of elections and file required campaign finance reports.
THIS DECLARATION CAN ONLY BE MADE AT THE BEGINNING OF AN ELECTION CYCLE.
_ I am withdrawing my Certification to remain at or under the $1,000 threshold. I will now be required
To file the next scheduled report for all contributions and expenditures that have not been previously
reported from the beginning of the current election cycle. I further agree to file all a reports required.
e iyned t WOW
RECEIVED
JUL 1 2 2023
Union Co. Board of Elections
CRO -3600 Certification of Threshold
RTH CAR
ELECTIO
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:
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
Treasurer Phone:
I 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 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.
Account Number Account Code 1
1
By signing this statement, I authorize agents of the State Board of Election o pect all accounts provided.
1 Z
Date igned a ure of Candidate or Tteastuer
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.
RECEIVED
Date Signed JUL 12 2-023Signature of Candidate or Treasurer
Union Co. Board of Elections
CRO -3500 Certification of Financial Account Information
NORTH CAROLINA
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 filed.
Candidate Name:
Committee Name:
Treasurer Name:
If Candidate is own treasurer, designate an agent to carry out designations:; M�2SCPP
Committee ID #: z 77 M'pj?LJ
Level Registered: [State] EEtyzly
county, specify: �(1� D
�s �5� hereby direct that in the event of my death or incapacity all
(Name)f 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 Entitv
(Select/ran §163-27d.16B(a)1
1. Pq
k
2.
3.
Plan for Disbursement (eg. Amount or %)
-0%
604o
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 shouldmaintained with the Committee
records. I n n7
Signature of Candidate;/ 1L
Date: RECEIVED
JUL 12 2023
CRO -3900 Candidate Designation of Committee FRnign Co. Board of Elections