Sangandi,Jerel_2025-SOG%Statement 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. Anis is re uired for each new election year.
1tlRnmmittepYinfnrmatinn
°:Namd. ED Number
e of Committee
.' Mailing Address (include City, State.aud Zip Code)e.-Date O-
foo s C'octio&L /.lf.'6� zA"'ha
. Committee Website (Optional) f.Phone Number i ;
SGaudidate)%formahon
a-A'Partyffiliation -.
`��R�L 3r�tt3c�tS�vr� t��l.
12c0ub4ciA�
tii'Mailing Address (Include City;. State, aad 7rp`Code) = " ` +
...... ....
L Office Sought
_ ..:
/da S 1.,�c�C L'iitcs� -�lri
N1itA--.
Tower CX .. ) ci L
'. PlioneN'amber'
d:;Emati Address �"
g. Next Election Year
h. Jurisdiction
�O�-ey 1
3Srfini t'tx1D�[� r�1FF�l.t
dog s
❑ Ematl copy of report notices
}Treasnier`.-lnformaho`tl r'F�` ,; .. ""V
4:!Asststantr7Yeasnre%Information
2:
.'Full Name'-"... - - `'
aFullName
�Le- SILPr tsPJSrl t 0
". Mailing Addr�csss (include City, State, and Zip Corti),
b. Mailing Address{'melude City, S d Zip Code)
V-31 L3J
``1 4 N/NN W Oa7
LPhone Namber
a -tit
d. Email Address f
#Vya0i gqev
*Ph one Nu" r
-
d. Email.Address
Send report notices by email Yes ❑ No
U Email copy of report notices
Ustodiimfof doks,Informatton( de er<ofRecords T36sAccoonflnformadon
:i(N�COtto3500) ss
. Full Name `
a. Financial Institution Full Name '
. Mailing Address (include City, State, and Zip Code)
_ -
c. Phone Number
Id. Email Address
b. Account Code
1c. Type
3S ► � 6`1
C t+EVIG ��
ZI 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.
X &82A 40USALO trg Ewa �jOO lonsmJW
Printed Name of Treasurer Signature of Appointed Treasurer Date
I certify that the information above is correct, and I, 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.
7-/77-a'
Printed Name of Candidate Signature of Candidate Date
2019
PG