Gay,William Dennis_2025-SOGStatement of Organization - Candidate Committee Is this statement:
19 New E3 Amended.
Use this form to create a new or update an existing candidate committee.
This form must be accompanied by lentil CRO -3500. An amended form is required for each new election year.
1. Committee Information
a. Name of Committee„ - - _ _
d. ID Number -
Cow,m�44,rco > o' RQ -ELcct Vewymp GQ
b. Mailing Address (include City, State and Zip Code)
e. Date Organized_
Slo(0 Olaf CY4CLrlaWne_� M61-ALin Aotiree ille 2Vlo
_
c. Committee Website (Optional)
f. Phone Number
70�
2.:CandidateInformation"
a. Full Name
e. Party Affiliation
/L ram �
No�02,91`4,rdkl
b. Mailing Address (include City, State, and Zip Code)
ca
d4„ r�r Ne 2Ps7
f. Office goug4t
CA(^nci tine
Number
di Email Address
g. Next Election Year
h. Jurisdiction
- p6p&
L
S �4i n less -b a a o 1. Cow,
2 023,
yyin, o -F
dNe4wn
mail co of report notices
3. Treasurer Information
4. Assistant Treasurer Information
a. Full Name -
a. Full Name
IAYt0411 //arw i
b. Mailing Address (include City, State, and Zip Code)
log a 4 Ch W �� 14) 14 �y
%12on Nef 21?//0
b. Mailing Address (include City, State and Zip Code)
c. Phone Numbef
d. Email Address
c. Phone Number
d. Email Address
Zsz 7Z3; S
r stltf { -zoo `s 7 b a 1 •
-
--- ----
Send repo notices by email M1 Yes ❑ No
Email copy of report notices
5. Custodian of Books Informatiom" Weeper of Records
6. Accounff.Informatinn: � (Incl: Cao -3500) " "s•.
a. Full NameI _
a. Financial Institution Full Name'
6ridoll #4rml Ga
b. Mailing Address (include City, State, and"Zip (',ode)
P06 Or�/� wp�
R
InOnree /✓4= 21//9
c. Phone Number
t S z2 -3-W
d. Email Address
I'e 14f Z-6-0
b. Account Code
It. Type
[E]' 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 andel �correct. /� CJ'at� �'P ._-'� III - I &Ac
Printed Name of Treasurer t Signature of Appointed Treasd - rer 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. �J
AI h, vtiAll
9edw/:( Gzi
Prinred�—
Name of Candidate Si6mature of Candida Date
W 0-2MOA NC Stale Board of Elections November 2019