Martin,Angel_2025-SOGStatement of Organization - Candidate Committee 15,this statement:
New ❑ Amended
Use this form to create a new or update an existing candidate committee.
This form must be accompanied by fomr CRO -3500. An amended form is required for each new election year.
1. Committee Information
a. Name of Committeed.
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ID Number -
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b. Mailing Address (inc ude:City,State and Zip Code) -
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e. Date Prgardzy
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c. Committee Website (Optional)
f. Phone Num er
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2. CandidateInformation
a. F11 Name -�
e. Par Affiliation -
b: Mallin ddress (1406de City,'Statc, andip Code) = -=- ,�
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f. Office So, ght
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c ..Phone Number
'd. EmailAddress AM J �trr�i V�� _
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s, Next. Election Year
h. Jurisdiction
❑ Email co of report notices
3. Treasurer Information
4'..Assistant TreasurerInformation
a. Full Name
a. Full Name
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b. Mailg dress (include City, State, anji Zi Code)-. - -
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b. Mailing Address (include City, State and Zip
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c. Phone Number '
d. Email Address
c. Phone Number 7
d. Emall Address UNIONCOUNT
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Send report notices,b y email - Yes - TI No
Email co of report notices
5. Custodian of Books Information(Keeper of Records
6. AccounhInformation (irict:'CRO=3500)
a. Full Name. " `a.
Financial institution Full Name -
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b. Mailin d res include City, State, and ip Cade)
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c. Phone Number -
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d. Email Add ess
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 pr ib ted or other non -disclosed funds. I further certify that
thisrep rt �n is complete, true and porrect.
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P inted Name of Treasurer 8101ature of Appointed Treasurer Date
I certify that the information above is correct, and I, as the ca i; ate, appoint said treasurer to personally fulfill the
duties and responsibilities imposed upon the appointed treas reran s bject to th penalties in Article 22A of Cha ter
163 of the NC Gene al Statutes. /
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Printed Name of Candidate Signature of Candidate Date
CRO -2100A NC State Board of Elections November 2019
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