Mills,Parker_2025-SOG Amendedstatement of Organization - Candidate Committee Is this statemei
n B'^mended
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 'd. ID Number
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b. Mailiog Address (include City, State and Zip Code) >e. Date Organized
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c. Committee Website (Optional)f. Phone Number
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2. Candidate Information - r
a. Full Name e. Party Anillatiori
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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
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3. Treasurer Information 4. Assistant Treasurer Information
a. Fuli Name a. Full Name
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b. Mailing Address (include City, State, and Zip Code) .b. Mailing Address (include City, State a^jZip Gp4^)\'?9pO &lucl.
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UNION COUNTY ^
c. Phone Number d. Email Address d. Email Add&QARD OF ELECTIONS-
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5. Custodian of Books Information (Keeper of Records)6; Account Information fine/. C/iO-3SOOJ
ai. Fuii Name , - , ■ ' ' .a. Financial Institution Full Name
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b. Mailing Address (inciudc City, State, and Zip Code)
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nil j-enfersor
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c. Phone Number d. Email Address b. Account Code c. Type
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□ 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 NCGeneral Statutes and that no funds are commingled wijb.^rohibited or other non-disclosed funds. I further certify thatthis report is complete, true and correct. ( i/ / /J ^
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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 the
duties and responsibilities imposed upon the appointed fi-easurer^nd subject to the penalties in Article 22A of Chapter163 of the NC General Statutes. / \ .1
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Printed Name of Candidate - \ Sighature of Candidate " Date
CRO-2100A V November 2019