Harris,Samuel_2025-SOGstatement of Organization - Candidate Committee
Use this form to create a new or update an existing candidate committee.
Is^s statement:
HD Amended
1. Committee Information
a. Name of Committee ' -d. ID Number
SaM (Wa.^ 'iti' C^i^i^\S5idf\€r
b. Mailing Address (Include City, State and Zip Coflc)e. Date Organized
\z/ilzs
c. Committee Website (Optional)f. Phone Number
76 V
2. Candidate Information
a. Full Name 'e. Party Affiljatlon
b. Mailing Address (Include City, State, and Zip Code).f. Office Sought
c. Phone Number .d. Email Address g. Next Election Year h. Jurisdiction
o sS 2 A (. ^iJniOT)Itl Email copy of report notices
3. Treasurer Information 4. Assistant Treasurer Information
a. Full Name a. Full Name
b. Mailing Address (include City, State, and Zip Code)b. Mailing Address (include City, State and Zip Code)
I3M
c. Phone Number d. Email Address c. Phone Number d. Email Address
ydfzuBoi 5^ kaoT S 920
. Send report notices by email 1 1 Yes 1 1 No O Email copy of report notices
5. Custodian of Books Information (Keeper of Records)6. Account Information (incl. CRO-ZSOO)
a. Full Name a. Financial Institution Full Name -
b. Mailing Address (Include City, State, and Zip Code)
RECElVliD
c. Phone Number d. Email Address b. Account Code
UNION COUNTY
ROARD OF ELECTIONSl^'^'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 non-disclosed funds. I further certify that
this report is complete, true and correct. ^ • t t
Printed Name of Treasurer Signature of Appointed Treasurer Date/
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 treasi^ and subject to the pennies in Article 22A of Chapter
163 of the N(j General Statutes. / \ i t
u J-—— {'i-Hhs
Printed Name of Candidate ^ Signature of Candidate Date