Epps,Robert_2025-SOGStatement of Organization - Candidate Committee Is t is statement:
new ❑ Amended
Use this form to create a new or update an existing candidate conunittee.
This form must be accompanied by form CRO -3500. An amended form is required for each new election year.
1. Committee Information
a. Name of Committee
it. ID Number
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b. MaWng_Address (Inc_ City, State ander Code)
e. Date Organized
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. Committee Website (Optional)
L Phline Number
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2. Candidate Information
a. Full Name
e. Party Affiliation
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It. Mailing Address (Include City, State, lip Code)
f. Office Sou t
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c . Phone Number
it. Email Address
g. Nest Election Year
It. Jurisdiction
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of re ort notices Ylf
3. Treasurer Information
4. Assistant Treasurer Information
a. Full Name
a. Full Name RECEIVED
It. Mailing Address (Include City, S aa/nfd Zip Code)
b. Mailing Address (inclu ty.7 a g�Ut�jIp Code)
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UNION COUNTY
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c. Phone Number
d. Email Address
c. Phone Number
iiettle
it. Email Address
Send re ort notices by enfAl WVs Ll No
U Email co ry of report notices
5. Custodian of Books Information (Keeper of Records
6. Account Information =_=(Incl. CRO -3500)
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a. Financial Institution Full Name
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It. Mailing Address (include Ci tate, and Zip Cade).
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.Phone Number
Id. Email Address
b. Account Code
c. Type
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51 Email copy of report notice
I certify that the Committee is in compliance with all applicable provision tc of Chapter 163 of the NC
General Statutes and that no funds are commingled with prohibited close unds. 1 further certify that
this rt is complete, truea and correct.
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Printed Name cYyeasurer
of Appointed Treasurer Odle
I certify that the information above is correct, and I e candidate,
appo urer to personally fulfill the
duties and responsibilities imposed upon the app ed treasurer and a to the pet lies in Article 22A of Chapter
163 of NC General Statute
Printed Name of daleignalurc
of Candidate Date
CKU-2100A p7C Ste card of Elections November 2019
PTH CAR
ELECTI
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 filed at the Board of Elections office where the committee's campaign reports
are filed.
FILED BY:
Committee Name:
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
BOARD OF ELECTIONS
Treasurer Phone:
Che One:
I certify that this committee intends to neither 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 remain 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.
THIS DECLARATION CAN ONLY BE MADE AT THE BEGINNING OF AN ELECTIQN ME E,
_ I am withdrawing my Certification to remain at or under the $ 1,000_tbFdbold. I will now be
to file the next scheduled report for all contributions and expendi es th Atno in
reported from the beginning of the current election cycle. I furthelagr%wille all future repo
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Elite Signed
CRO -3600
of Threshold
NORTH CAROLINA
g)
STATE BOARD OF ELECTIONS
Confidential
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:
Treasurer Address: RECE
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(include city, state, & zip) /J%ry/r. NL ggl %3 IUL 2 8 2025
Treasurer Phone: 712q—,6-4/2— UNION COUNTY
BOARD Of ELECTIONS
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 desienate 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.
Ty
ype of account Financial Institution Address Account Number Account Code
By signing this statement, I authorize agents of the State Board of Elections to inspect all accounts provided.
Date Signed Signature of Candidate or Treasurer
For Candidate Committees Only
In lieu of providing account information, I certify that this committee will not raise any mo nd any money
except that which is the candidate's personal funds. I furthermore understand t audit or invests ation could
warrant the probe of any personal bank account that is being used for campai expenditures.
By signing this s tement, I authorize agents of the State Board of Electi inspect applica ccounts.
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Date gigned of Candidate or Treasurer
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CRO-3500 Certification of Financial Account Information