Gemignani,John_2025-SOGStatement of Organization - Candidate Committee I Is this statement:
® New ❑ Amended I
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 Wear.
1. Committee Information
a. Name of Committee
d. ID Number
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b. MWft Address (include City, State and Zip Cade)
e. Date Organized
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c. Co®ittee Welositokftdomill
E Phone Number
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2. Candidate Inf rmation
a. FunName
e. Party _
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b. Mailing Address (includ City, State, and Zip Code)
C Ontee Sought
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. Phone Number
d. Ercall Address
g. Next Election FearTW
Jurisdiction
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❑Email co of re oRnotices
3. Treasurer In ormatioa
4. As stent Treasurer Information
a. Full Name
a. Full Name
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. Mailing Address (include City, State, Zip Code)
b. Mailing Address (include City, State and Trp Code)
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. Phone Number
d. Email Address
c. Phone Number
d. Email Address
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Send report notices by email El Yes Ll To
Eniail copy of report notices
5. Custodian of Books Information (Keeper of Records
6. Accannt Informatlo fiqcL go -3500)
a. Full Name
a. Finaoclal Ins
b. Mailing Mailing Address (include City, State, and Zip Code)
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c. Phone Number
d. EmaB 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 -disclosed funds. I further certify that
this report is complete, true and correct.
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Printed Mine of TreaVkr
Tfate
I certify that the information above is correct, an?aas candidate,
appoint said treasurer to personally fulfill the
duties and responsibilities imposed upon the appointed treasurer and subject t e penalties in Article 22A of Chapter
163 of the NC General Statutes.
.jot1� GiHthon� %{ragf(leYu'll 1,
Printed Name Caodt�
A .`lO�
Signam f
of
Candi ate
CRO -1100A � NC State Board of Elections November 2019
VOTE
rT1T�
NORTH CAROLINA
STATE BOARD OF ELECTIONS
Candidate Designation of Committee Funds
This form is used by candidate committees only and allows the candidate to designate in the event of their death,
how the committee's funds are to be disbursed using the eight allowable methods outlined in 163-278.16B(a).
This Designation is Filed at the Board of Elections office where the committee's campaign reports are riled.
Candidate Name: Joh A
Committee Name: e\ Fv I- w0 -x K& LA) .GDM
Treasurer Name: Jo� A�"AV G2eM'9A&
&YtI
If Candidate is own treasurer, designate an agent to carry out designations:
Committee ID #:
Level Registered: [State] [County] If county, specify: MuniU I —CUU N
I, Jotin 4rJJ"V (; iM%qna- I , hereby direct that in the event of my death or incapacity all
(Name of C didate)
funds remaining in my Campaign Committee account(s) (after payment of permitted outstanding
debts or reasonable expenses for winding up the Committee or closing office) be paid in the
following manner as permitted by N.C. Gen. Stat. 163-278.16B(a).
Name of Entity Plan for Disbursement (et?. Amount or %)
(Select from §163-278.16B(a))
1. Union County GOD
2. �Z�ytu, acre t1
3.
33%
S
By signing this form, I certify that the foregoing entities are eligible beneficiaries under N.C.
Gen. Statute 163-278.16B(a). A co y this form should be �aintained with the Committee
records. A , t 4A.
Signature of Candidate:
Date:
Candidate Designation of Committee Funds