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Chambers,Teresa_2025-SOGStatement of Organization - Candidate Committee Is this statement: El New ❑ pinended 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 reouired for each new election venr- 1. Committee Information a. Name of Committee - d. ID Number m ee a b. Mailing Address (include City, State and Zip Code) e. Date Orga tied _ 566hskill arc�� c. Committee Website (Optional) - f. Phone Number " 2. Candidate Information - ---- - - a. FuIQ 2aW' e. Party Affiliation b. Mailing Address (include C , State, and Zip Code I. Office Sought ' 3� So t/J`nll'11�/ AA 6-a cb3 c. Phone Number -14 Email Address . - g. Next Election Year ,: h Jurisdiction 6�tav�bev�&lhoo Email copy ore ort notices 3.. Treasurer Information 4. Assistant Treasurer Information a. Full N�aam_ e - a.Full Name - - - L�1 /' �� lam%" � b. Mailing Address (includ ty, State, and Zip,Code) It. Mailing Address (include City, State and Zip Code) 05 h Lit' 2 D c. PhoneNumber Id.Address c. Phone Number , d. Email Address �EJmail Q Send report notices by email Yes No Email co of report notices 5. Custodian of Books Information (Keeper of Records , 6. Account Information (incl. CRO -3500) " a. Full Name a. Financial Institution Full Name b. Mailing Address (include City,. State, and Zip. Code) - c. Phone Number -. 6Email Address b. Account Code c. Type - ❑ 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. 1 further certify that tts report is complete, t e a d correct. �p 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 responsibilit&imsedpon the appointed treasurer and subject to the penalties in Article 22A of Chapter 163 a NC General Printed NaSignature of Candidate Date (7. U-21 UUA �1� NC State Board of Elections November 2019 )A VOTE © NORTH CAROLINA mT� STATE BOARD OF ELECTIONS Certification of Threshold This Certification is used to declare or withdraw a committee's intent to raise or spend $1,000 or less in the current election cycle. This Certification is only valid for political party committees and candidates for a county office, municipal office, local school board office, soil & water conservation district board of supervisors, or sanitary district board. This Certification is riled at the Board of Elections office where the committee's campaign reports are £ded. FILED BY: Committee Name: �i(M Treasurer Name: T�tr•escL C �, 1 a-ry'1 ber—$ Treasurer Address: 59 u /,r-1 (include city, state, & zip) kr �,,h Vi II e— N,(2-. a g t1 Q r. RECEIVW Treasurer Phone: JUL 2 3 2025 UNION COUNTY Ch One: BOARD OF ELECTIONS I certify that this committee intends to net er 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. TFBS DECLARATION CAN ONLY BE MADE AT THE BEGINNING OF AN ELECTION CYCLE. _ I am withdrawing my Certification to remain at or under the $1,000 threshold. I will now be required to file the next scheduled report for all contributions and expenditures that have not been previously reported from the beginning of the current election cycle. I furt agree to file all future 'e orts required. - g _ 7 Date Signed sigh"6i CRO -3600 Certification of Threshold NORTH CAROLINA g) STATE BOARD OF ELECTIONS Con dentia[ Certification of Financial Account Information This Certification is used to report confidential bank account information for all financial accounts established by the committee and must accompany the Statement of Organization Form. FILED BY: Committee Name: Treasurer Name: c- ` Treasurer Address: �3J� yj /,L7r 1 - / ✓i (include city, state, & zip) /�� ✓ In f' I Q N t (�. o?$ (� 3 Treasurer Phone: 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 (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. Type of account Financial Institution Address RMWhfter Account Code W 11; IN' TY ' By signing this statement, I authorize agents of the State Board of EleceJMR iUpgcEe�fr6Wpts provided. Date Signed Signature of Candidate or Trcasurcr 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. signing this statement, 1 authorize agents of the State Bo f Elections to i p t a➢ able accoun s. Date Signed Signature idate or Treasurer CRO -3500 Certification of Financial Account Information