Lewis, Derrick_2025-SOGstatement of Organization - Candidate Committee
Use this form to create a new or update an existing candidate committee.
Is this statement:
Bj D Amended
1. Committee Information . .
a. Name of Committee ^■4 'd. ID Number
Committee to elect Derrick Lewis for School Board District 4 UJM6GN
b. MaUina Address Onclude City, State and Zip Code)e. Date Organized
1008 Laggan Lane, Indian Trail, NC 28079 12/18/2025
c. Committee Website (Optional) < .fL Pbone Number - ■
704-258-7119
2. Candidate Information
a. Full Name e. Party Affiliation.
Derrick Lewis Democratic Party
b. Mailiag Address QiicIude.Cityj'State, and Zip Code) >.f. Oilice Sought
1008 Laggan Lane, Indian Trail, NC 28079 Board of Education
c. Ffaone Number d.'EmnU Address , <g. Next Election Year b. Jurisdiction
704-258-7119 dlewisspecial@gmail.com 2026 Union County
□ Email coov of report notices
3^ Treasurer Information 4. Assistant Treasurer Information
a. Full Name a. Full Name .
Dem'ck Lewis
b. Mailiag Address (incldde City, State, and'Zip' Code)b; Mailing Address (include City, State and ap Code)
1008 Laggan Lane, Indian Trail, NC 28079
c. Pbone Number.d. Einail Address c. Phone Number d. Email Addr^
704-258-7119 dlewlsspecial@gmall.com
- Send report notices bv email kIYcs I_INo U Email copy ofreport notices
5. Costodian of Books Information (Keeper of Records)6. Account Information (incl. CRO-JJOO; . ^ •
a. Full Name a. Financial Institntioo Full Name
None RPrFi\/Fn TruistBank
b. Mailing Address (include City, State, and Zip Code) ," ■-■■■ ■■ . - V-'-
DEC 2 9 2025
c. Pbone Number d. EmailMthfiifeliCOUN i Y b. Account Code c.,Type,'';"':. ■ .. ' ' ■_board Oh tLtUl lONS
1 CheckingP Email copy of report notices
I certify that the Committee is in compliance with all applicable provisions ofArticle 22A of Cliapter 163 of the NC
General Statutes and that no funds are commingled with prohibited ob otiier non-disclosed funds. I further certify that
this report is complete, true and correct. ^ Jj ■ <
Derrick Lewis >12/29/2025
Printed Name of Tieasurer Signature of Appointed Treasurer Date
1 certify that the information above is correct, and I, as the candidate, appoint said treasurer to personally fulfill the
duties and responsibilities imposed i^on the appointed treasurer and ^bject to the penalties in Article 22A of Chapter163 of the NC General Statutes. /)
Derrick Lewis ^ 12/29/2025
Printed Name ofCandidate Signature ofCandidate Date
CRO'2100A NC State Board ofElections November 2019