McCoy, Kensley_2025-SOGStatement of Organization - Candidate Committee
Use this form to create a new or update an existing candidate committee.
This form must be accompanied by fonn CRO-350Q. An amended form is required for each new election year.
Is this statement:
Amended
1. Committee Information
a. Name of Committee
l/vmiu-j HcXou Coor\c'i}n Mailing Address (include City, State and Zip Code) ^
'^I09 (AJilSQn ^gyyl/e MCZ-gliD
c. Committee Website (Optional)
2. Candidate Information
tl. ID Number
aima?
e. Date Organized
r. Phone Number
a. Full Name
I^CCoLi
b. Mailing Address (include City, State, and Zip Code)
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c. Phone Number d. Email Address
□ Email copy of report notices
3
e. Party Affiliation
f. Office Sought
(S/V-y counci'i
g. Next Election Year h. Jurisdictionci'^Or
. Treasurer Information 4. Assistant Treasurer Informationa. Fpll Name a. Fiill Name
b. Mailing Address (include City, State, and Zip Code)b. Mailing Address (include City, State and Zip Code)^10^ WilSon , iHo^e
c. Phone Number
w-i'i-i'om
d. Email Address
A rwcCt/y -Ccyyi c. Phone Number
Send report notices by email □ Yes □ No
d. Email Address
D^maij^py of report noti^
65. Custodian of Books Information (Keeper of Records).. Account Information (ind; CRO-3SOO)
a. Full Name
TECEIVED"
a. Financial Institution Full Name
b. Mailing Address (include City, State, agd Zip C}}^)Mate, and ZiDEdtf-
c. Phone Number d. EnB(t)^^@F ELECTIONSUNION COUNTY
D Email copy of report notices
b. Account Code c. Type
ACorPUW^O^0C\(^'n(^
I certify that the Committee is in compliance with all applicable provisions of Article 22A of Chapter 163 of the NO
General Statutes and that no funds are commingled with prohibited or other non-disclosed funds. I further certify thatthis report is complete, true and correct. \ /, fi \l-30-zy\
Printed SlAme of Treasurer IJ re 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 treasurer aijjd subject to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
PnntetvName of Candidate wmature of Candidate
NC State Boardibf Elections
\'2 -30-^r
CRO-2100A November 2019