Ball, Michelle_2025-SOGStatement of Organization - Candidate Committee
Use this form to create a new or update an existing candidate committee.
Tjii^jbrmjnust^gjccompanied by form CRO-3500. An amended form is required for each new election year.
Isthj^^tatement:
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'1. Committee Information
a. Name of Committee
b. Mailing Address (include City, State and Zip Code)
c. Committee Website (Optional)! fOntionah
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2. Candidate Information
d. ID Number
c. Date Organized
f. Phone Number
a. Full Name
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b. Mailing Address (include City, State, and Zip Code)
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c. Phone Number d. Email Address
G3^mail copy of rep^ notices
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e. Patty Affiliation
f. Offlce Sought
g. Next Election Year h. Jtirlsdiction
. Treasurer Information
a. Full Name
4. Assistant Treasurer Information
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a. Full Name
b. Mailing Address (include Cit}-, State, jtnd Zip Code)•^s (include Lit}-, State, and Zip Code)
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b. Mailing Address (include City, State and Zip Code)
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c. Phone Number
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d. Email Address c. Phone Number d. Email Address
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Send report notices by email DVes □ No
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□ Email copy of report notices'
65. Custodian of Books Information (Keeper of Records). Account Information ilnd. CRO^iSOQ)
a. Full Name a. Financial Institution Full Name
b. Mailing Address (include City, State, and Zip Code)
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c. Phone Number d. Email Address b. Account Code c. Type
J Email copy of report notices C. heejLuvs
I certify that the Committee is in compliance with all applicable provisions of Article 22A of Chapter 163 of the NOGeneral Statutes and that no funds are commingled with prohibited or other non-disclosed funds. I further certify thatthis ijep^rt is complete, true and ^rrect. — /^v/\ vO
Printed Name of Treasurer Signature tf Appointed Treasure 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 treasurer and subject to the penalties in Article 22A of Chapter
Signature ovCandidate
CRO-2100A NC State Board of Elections November 2019