pepper,abigail_2025-SOOStatement of Organization - Candidate Committee .I.J IIss�this statement:
New ❑ Amended
Use this form to create a new or update an existing candidate committee.
This fi . must he arrmmnnnied 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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. Mailing Address (include City, State and Zip Code) -
c. Date Organized
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. Committee website (Optional)
f. Phone Number
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2. Candidate Information
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a. Full Name _ _
e. Party Affiliation
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b. Mailing Address (include City, State, and Zip Code)
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. Phone Number d. Email Addras
g. Next Election Year
b. Jurisdiction
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3. Treasurer Irrformation
4. Assistant Treasurer Information
a. Full Name
a. Full Name
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b. Mailing Address (include City, State, and Zip Code) _
b. Ma -sling Address (Include City, State and Zip Code)
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c. Phone Number
Id. Email Address
c. Phone Number
d. Email Address
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5. Custodian of Books Information (Keeper of Records
6. Account Information (h,cL CRO -3500)
a. Full Name
a. Financial Institution Full Name
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b. Mailing Address (include City, State, and Zip Code)
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. Phone Number
d. Email Address
b. Account Code
c. Type
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1 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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PrimeName of reasurer signature of.�ppointdTreasurer ate
1 certify that the information above is correct, and 1, as the candidate, appoint said treasurer to personally fulfill the
duties and responsibilities imposed upon the appointed treasurer and subject to the penalties in Article 22A of Chapter
163 ofthe NC General Statutes.
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Signature of Candtdat�- Date
CRO -2/00.4 NC State Board of Elections November 2019
O
VOTE
�ITT�
NORTH CAROLINA
STATE BOARD OF ELECTIONS
Certification of Threshold
This Certification is used to declare or withdraw a committee's intent to raise or spend S 1,000 or less in the
current election cycle.
This Certification is only valid for political party committees and candidates for a county office,
municipal office, local school board office, soil & water conservation district board of supervisors, or
sanitary district board.
This Certification is filed at the Board of Elections office where the committee's campaign reports
are filed.
FILED BY:
Committee Name:
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
fyWyot, Yu, E% ALO
Treasurer Phone: --I-C>LA - S 9'b - Cele -?-2
Chec One:
I certify that this committee intends to neither receive not expend more than $1,000 during the current
election cycle under the procedures set forth in G.S. 163-278.10A. This certification will remain in effect
until the end of the election cycle for this committee. If this committee exceeds $1,000 in contributions or
expenditures during this election cycle, I understand that I must immediately notify the appropriate board
of elections and file required campaign finance reports.
THIS DECLARATION CAN ONLY BE MADE AT THE BEGINNING OF AN ELECTION CYCLE.
_I am withdrawing my Certification to remain at or under the $1,000 threshold. I will now be required
to file the next scheduled report for all contributions and expenditures that have not been previously
reported from the beginning of the current election cycle. I further agree to file all future reports required.
Date Signedgin =
CRO -3600 Certification of Threshold
( 2M
VOTE NORTH CAROLINA
�T1T� STATE BOARD OF ELECTIONS
Candidate Designation of Committee Funds
This form is used by candidate committees only and allows the candidate to designate in the event of their death,
how the committee's funds are to be disbursed using the eight allowable methods outlined in 163-278.16B(a).
This Designation is tiled at the Board of Elections office where the committee's campaign reports are filed.
Candidate Name:
Committee Name:
Treasurer Name: At0%a PGv
If Candidate is own treasurer, designate an agent to carry out designations: jolhtMir LV i S
Committee ID #:
Level Registered: [State] [County] If county.
I, Cait1 QBPOPX hereby direct that in the event of my death or incapacity all
Name of endidete)
funds remaining in my Campaign Committee account(s) (after payment of permitted outstanding
debts or reasonable expenses for winding up the Committee or closing office) be paid in the
following manner as permitted by N.C. Gen. Stat. 163-278.16B(a).
Name of Entiri
(Select from §163-278.16B(a)1
1. ��IV�Sth�t GiiC�it,�tG
2.
a
Plan for Disbursement (eg. Amount or %)
By signing this form, I certify that the foregoing entities are eligible beneficiaries under N.C.
Gen. Statute 163-278.16B(a). A copy of this form should be maintained with the Committee
records.
Signature of Candidate: �n
Date:__�� 210
CRO -3900 Candidate Designation gfCommittee Funds