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Atkinson,Jeff_2019-CommitteeAmen ent Statement of Organization - Candidate Committee Yes ❑ No Use this form to create a new or update an existing candidate committee. This form must be accompanied by forms CRO -3100 and CRO -3500 when amending, only re -submit if applicable). 1. Committee Iaformation . Full Name- c. ID Number // THE Vo-rE JEFF A TKINSON L�OMALTTEL- A TK I I t3 .Mailing Address (include City, State and Zip Code) d. Date Organized ESO-) tn(IOTENAWK 140-1 Ro. In/A X H A W rJG 28173 JUN 27 2019 Union Co. Board of Flections V 2 9 30is e. Phone Number (704) v I1- v 49 r 2. Candidate Information OCandidate's Primary Committee . Full Name e. Candidate ID Number if. Party Affiliation JI=Fr RcV FZ.arV ATKINS O:� RE P06LICAr.I (Indicate Non-partisan if applicable) rMailing Address (include City; State, and Zip Cade) g. Office Sought - 85oi %^(W rT LOA WK I-1,�L W A x H A V4, NG 23173 . Phone Number d. Email Address h. Next Election Year 1. Jurisdiction (704) 641-41F91 , eFF, a4k+,,son@ w(nAsirenm. et V N i ON Gc.�.v r�( ©Email copy of notices . Treasurer Information - 4. Custodian of Books Information . Full Name(r,� a. Full Name �Ax"rER WARE J-TAANES �AK TEI?_ V�IA0.E STA 0.NES . Mailing Address (include City, State, and Zip Code). b. Mailing Address (include. City, State, and Zip Code). P. o. aox 1$07 AAoNROE, fQC- 28111 P. e�. r3ox 180'7 MON0.oE, NG 28111 ', Phone Number Id. Email Address c. Phone Number Id. Email Address' (704)589-C)9 6nxsiurl973@ oet+la,ak.ea (704) 589-o06f baxs�ar1973Cr ovila�k•c: I prefer to receive notices by email Yes No Email copy of notices - . Assistant Treasurer Information U Add I ❑ Remove 6. Account Information kql.. CR73500) Add ❑ Remove . Full Name a. Financial Institution Full Name WEt• t_S FAA.60 f,ANK b, Mailing Address (include City, State, and Zip Code) b. Purpose CFiecodimc, A•GCOu Nr POR C.OMMIrrE . PhonL d. Email Address c. Account Code d. Type C UCCK LN C, notices CERTIFICATION I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 22D -22M of Chapter 163 of the NC General Statutes and that no funds are commingled with prohibited or other non -disclosed funds. jthis f report is complete, true and correct. j II7f^furtthherrccertify that Nfrc / � c(l/q/«- cS�%'��� G✓i,-. to 'a 6 --� Printed Name of Signer Signature of Appointed Treasurer Date CRO -2100A NC State Board of Elections July 2011 NORTH CAROLINA Suite Board of Elections & Ethics L:dorcement Certification of Treasurer This Certification is used by Candidate Committees to appoint a treasurer for the committee. This form is required and must accompany the Candidate's Statement of Organization. This Certification is Bled at the Board of Elections office where the committee's campaign reports are fled. RECEIVED FILED BY: Candidate Name: Treasurer Name: Treasurer Address: (include city, state, & zip) AFF �}T14�ia�td,J JUN 2 7 2019 Union Co. Board of Elections I�flX%49� Gr%(ah��� crJ/iJES Aq. eaX /CW? 1170100tc,—, /VL— �2('/// Treasurer Phone: 7e71 -6P9 I certify that the above information is correct, and I, as candidate, appoint said treasurer to personally fulfill the duties and responsibilities imposed upon the appointed treasurer and subject to the penalties and sanctions in Subchapter VIII. Regulation of Election Campaigns of Chapter 163 of the North Carolina General Statutes. I understand that if the above Treasurer changes, it will be necessary to certify a new treasurer and amend the existing Statement of Organization within 10 days of the vacancy. I further understand that the above Treasurer is required to receive training by the State Board of Elections within three months of this appointment according to Article 163.278.9(k). Zn #stv� Date Sign d Signature of Candidate CRO -3100 CerCdreation of Treasurer