Ilarraza,Fred_2025-SOStatement of Organization - Candidate Committee Is this statement:
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Use this form to create a new or update an existing candidate committee.
This form must be accom anied by form CRO -3500. An amended form is required for each new election year.
1. Committee Information
a. Name of Committee,�/
d. ID Smnher
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b. MaBing Address (include City, State and Zlp Cade)
e. Date Organized
c. Committee Website (Optional)
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f. Phone Number
91 -7 -i -y 6167
2. Candidate Information
a. Fulll Name
e. Party .Affiliation
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b. Maaing Address (include City, State, and Zip Code)
I. Office Sought
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c. Phone Number
d. Email Address
g. Next Election Year
h. Jurisdiction
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® Email copy ofreport notices
3. Treasurer Information
4. Assistant Treasurer Information
a. Full Name
a. Full Name
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b. Mailing Address include City, Stat d Zip Code)
b. Mailing Address (include City, State and Zip Code)
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c. Phone Number
d. Address
c. Phone Number
d. Email Address,
Email
Send report notices by email Yes No
Ll Email copy of report notices
5. Custodian of Books Information (Keeper of Records
6. Account Information (MCL CRO -3500)
a. Full Name
a. Financial Institution Full Name
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b. Mailing Address (include Clty, State, and Zip Code)
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c Phone Number
d. mail Address
b. Account Code
c. Type
Email copy of report notices
I certify that the Committee is in compliance with all applicable provisi Article 22A of Chapter 163 of the NC
General Statutes and that no funds are commingled with prohib' d er non -disclosed funds. l further certify that
this repfoo is complete, true and correct.
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Printed Name of Treasurer Signature of Appointed Treasurer Date
I certify that the information above is correct, and 1, as the candidate, appoin said tr urer to personally fulfill the
duties and responsibilities imposed upon the appointed treasurer a clt to enalties in Article 22A of Chapter
163 of the�iVC,�ieneral tes.
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Printed Name of Candidate Signature of Candidate
CRU -Ll UUA NC State Board of Elections November 2019