Dotson,David_2025-SOOStatement of Organization - Candidate Committee Is this statement:
❑ New ❑ 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 required for each new election year.
1. Committee Information
a. Name of Committee
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d. In Number
b. Mailing Address (include City, State and Zip Code)
e. Date Organized
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c. Committee Website (Optional)
f. Phone Number
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2. Candidate Information
a. Full Name
e. PRM Affiliation
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b. Mailing Address (include City, State, and Zip Code)
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. Phone Number
d. Email Address
g. Neat Election Year
h. Jurisdiction
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❑ Email copy of report notices A1A'1G.
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. Treasurer Information
4. Assistant Treasurer Information
a. Full Name
a. Full Name
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It. Mailing Address (include City, State, and Zip Code)
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It. Mailing Address (include City, State and Zip Code)
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c. Phone Number
Id. Email Address
c. Phone Number Id. Email Address
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Send report notices by email 0 Yes
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5. Custodian of Books Information (Keeper of Records
6. Account Information (incl CRO -3500)
a. Full Name
a. Financial Institution Full Name
b. Mailing Address (include City, State, and Zip Code)
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c. Phone Nundn'r
d. Email Address
b. Account Code
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H�UEIVED
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1 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 commingledwith prohibite or other non disclosed funds. 1 further certify that
this report is complete, true and correct.
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Printed Name of Treasurer Signature or Appointed Treasurer Date
I certify that the information above is correct, and 1, as the candidate, appoint said treasurer to personally falfill the
duties and responsibilities imposed upon the appointed treasurer and subject to the penalties in Article 22A of Chapter
163 of thee NCC General Statutes.
Printed Name of Candidate Signature of Candidate ate
CRO -2100A NC State Board of Elections November 2019
NORTH CAROLINA
TATE 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 163-278.1613(a).
This Designation is filed at the Board of Elections
Candidate Name:
where the committee's campaign reports are filed.
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Committee Name:ij�/�T GL- TTS 4 GG /�d/l J (�
Treasurer Name: L5 C—�Sj lrnA L
If Candidate is own treasurer, designate an agent to carry out designations:
Committee ID M
Level Registered: [State] [County] If county, specify:
I, , hereby direct that in the event of my death or incapacity all
(Name of Candidate)
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 Entitv Plan for Disbursement (ca. Amount or %)
(Select from §]63-178.76B(a))
1. C 01zy�$ ^)N 6 F!5 A"s l00
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2.
3.
By signing this form, I certify that the foregoing entities are eligible beneficiaries under N.C.
Gen. Statute 163-278.16B(a). A copy of this form should be maintained with the Committee
records.
Signature of Candidate:
Date:
CRO -3900 Candidate Designation of Committee Funds