Amburgey,Michael Thomas_2025-SOGStatement 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
LCommittee Information
a. Name of Committee - - -
d. ID Number
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1). Mailing Address (include City, State and Zip Code)
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e. Date Organized
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c. Committee Website (Optional)
fPhone Number
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2' Candidate Information--- -
a. Full Name'
e. Party Affiliation
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b.. Mailing Address (include City, State, and Zip Code) - -
f. Office Soug t
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r. Phone Number
G. Email Address
g.; Next Election Year
It. Jurisdiction
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❑ Email copy of report notices
1 Treasurer Information
4. Assistant Treasurer Information
a. Full Name - -
a. Full Name
b. Mailing Address (include City, State, anfl Zip. Code) -
b. Mailing Address (include City, State and Zip Code)
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c. Phone Number
d. Email Address
c. Phone Number _
d.. Email_ Address
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S. Ctodian of BooksIuformation. Keeper of Records
6. Account: Information (mcL CRO -3500)
a. Full Name " -
a. Financial Institution Full Name
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b. Mailing Address (include City, State, aWd ZipCode).
c. Phone Number
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d. Email Addressb.
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Account Code
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c: Type '
❑ Email copy of report notices
1 certify that the Committee is in compliance with all applicable provisions of Article 22A o pter 163 of the NC
General Statutes and that no funds are commingled with proh' ' ed or ther non-disclos funds. I further certify that
this report is complete, true and correct.
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Printed Name of Treasurer Signmu o ppointed Treas D to
t saidOasorerto personally fulfill
ditties and responsibilities imposed upon the appoe penalties in Article 22 Chapter
I certify that the information above is correct, andM==
163 of the NC General Stat4C.nd
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CRO-2ium NC State Board of cctions November 2019