Mills,Parker_2025-SOGstatement 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 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. ID Number
b. Mailing Address (include City, State and Zip Code)e. Date Organized
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c. Committee Website (Optional)f. Phone Number
2. Candidate Information
a. Full Name
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e. Part>' Affiliation
b. Mailing Address (include City, State, and Zip Code)f. Office Sought
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c. Phone Number d. Email Address g. Next Election Year h. Jurisdiction •
□ Email copy of report notices
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3. Treasurer Information 4. Assistant Treasurer Information
a. Pull 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 Address
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□ Email copy of report notices
5. Custodian of Books Information (Keeper of Records)6. Account Information (incl. CRO-3500)'
a. Full Name a. Financial Institution Full
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b. Mailing Address (include City, State, and Zip Code)
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UNION COUNTY
O'^ELECTIUISItjc. Phone Number d. Email Address b. Account Code
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□ Email copy of report notices
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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
this report 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 I, as the candidate, appoint said treasurer to personally fulfill theduties and responsibilities imposed upon the appointed tj^^urer^d subject to the penalties in Article 22A of Chapter163 of the NC General Statutes. / j 1 130 L ^ ^ 99-13^Printed Name of Candidate V ^/^ignatureofCandidat^^^^^^^^^^^^^^^Dat^^^^
CRO-2100A NC State Board of Elections November 2019