Banks,Melissa_2025-SOGStatement of Organization - Candidate Committee Is phis statement:
❑' tett ❑ Amended
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 vear.
1. Committee Information
a. Name of Committee
it. ID Number
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. Mailing Address (include City, State and Zip Cade)
e. Date Organized
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a Committee Website (Optional)
I. Phone Number
2. Candidate information
a. ILII Name
e. Party Affiliation
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It. Mailing Address (include City, State, and Zip Code)
I. Office Sought
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c . Phone Number
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d. Email Address
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g. Nest Election Year
h. Jurisdiction
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3. Treasurer Information
4. Assistant Treasurer Information
a. Full Name
a. Full Name
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b. Mailing Address (include City, State, and Zip Code)
b. Mailing Address (include City, State and Zip Code)
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c. Phone Number
d. Email Address
c. Phone Number
d. Email Addre#JL 16 2025
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5. Custodian of Books Information (Keeper of Records
6. Account Information (inti. CRO -3500)
a. Full Name
a. Financial Institution Full Name
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It. Mailing Address (include City, State, and Zip Code)
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c. Phone Number
d. Email Address
It. Account Code
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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
thisreportis complete, true ancdd correct.
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11K�1 z. 110y, Tim VJ
Printed Name of Treasurer Sianza Appointed Treasurer Date
I certify that the information above is correct, and 1, 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 oftheNC General Statutes.
MW (Avtr F701L& 0
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Printed Name of Candidate
Sibma re oCC'andidate is
CRO -2100A NC State Board of Elections ',. ,nbcr 2019
NORTH CAROLINA
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, soft & 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)
Treasurer Phone: $ y3. 3Q 7 — L t► 63
Check One:
L, -fl 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 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 further agree to file all future reports required.
2 -
Da a Signed
CRO -3600
c4tum
Certification of Threshold
RECENED
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UNION Lu""' c
04 01: ELECTION'