Change For Monroe_2024-Stmt-OrgAmendment
❑ Yes ❑ No
Statement of Organization - Independent Expenditure Political Committee
Use this form to create a new or update an existing Independent Expenditure Political committee.
This form must be accompanied by form CRO -3500.
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CERTIFICATION �x
I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 22D -22M 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 and that I certify that the above named political committee
is registered with the North Carolina State Board of Elections and does not and will not make any contributions as
defined by N.C. Gen. Stat. 163-275.6(6), directly or indirectly, to a candidate or a political committee that makes
contributions to candidates. Political committees signing this certification are not subject to the contribution limitations
set forth in subsections (a) and (b) of N.C. Gen. Stat. 163-278.13 but must abide by all other provisions of Article 22A
of Chapter 163 of the North Carolina General Statutes. If the political committee determines that it no longer wishes to
adhere to this certification, then it must immediately notify the North Carolina State Board of Elections before any further
deposits or expenditures are made by the political committee.
If Treasurer is outside of NC, both the Treasurer and NC Assistant Treasurer must sign Certification.
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Printed Nuine of Signer SignatureofAppointed Treasurer Date
Printed Name of Signer Signature of NC Assistant Treasurer Date
CR0-27000 NC State Board of Elections March 2012
v 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:
Treasurer Name: Inc veVit ->o rl-t t�s
Treasurer Address:i�.0. ZpX 3qs
(include city, state, &zip) Montbe, tSC_ a8M
Treasurer Phone: (gb11 919 - g 3 m a
a
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 (anv 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
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By signing this statement, I authorize agents of i
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Dat igned
For Candidate Committees Only
- -—.._r.ivided.
Signature otCandidate or Treasurer
J 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 Account Information