Petterson,Heidi_2025-SOGstatement of Organization - Candidate Committee I^his statement:
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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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b. Mailing Address (include City, State and Zip Code)■J>\US C\r-x^WvJ^QOg>t i^lVlevinodUC'18110
c. Committee Website (Optional)
2. Candidate Information
d. ID Number
e. Date Organized
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f. Phone Number
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a. Full Name
b. Mailing Address (include City, State, and Zip Code)
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c. Phone Number
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d. Email Address
IS Email copy of report notices
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e. Party Affiliation
f. Offlce Sought
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g. Next Election Year oh. Ju
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risdiction
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. Treasurer Information 4.,Assistant Treasurer Information
a. Full Name a. Full Name
b. Mailing Address (include City, State, and Zip Code)
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Tlione d. Email Address
b. Mailing Address (include City, State and Zip Code)
c. Phone Number c. Phone Number
Send report notices by email S Yes □ No
d. Email Address
5. Custodian Of Books Information (Keeper of Records)
D Email copy of report notices
6; Account Information (incl. CRO-SSOO) -
a. Full Name a. Financial Institution Full Name
b. Mailing Addrcs^fnUNln^f
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tfZip Code)
c. Phone Numbcrr
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b. Account Code
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c. Type
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I certify that the Committee is in compliance with all applicable provisions of Article 22A of Chapter 163 oftheNC
General Statutes and that no funds are commingled with prohibited or other non-disclosed funds. I further certify that
this report is complete, true and correct. ia . /\ , j'?(J:Uy5>6y( ^y\mL
Printed Name of Treasurer Signature of Appointed Treasurer Date
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I certify that the information above is correct, and I, 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 of the NC General Statutes.of the NC General Statutes.< t w/| j / _
Printed Name of Candidate Signature of Candidate DaleSignature of Candidate
CRO-2100A NC State Board of Elections November 2019