Ayers,Steven_2019-CommitteeAmendment
Statement of Organization - Candidate Committee ❑ yes ❑ No
Use this form to create a new or update an existing candidate committee.
This form must be accom ied by forms CRO -3 100 and CRO -3500 when amendin onl re -submit if a I'cabl
t e
L Committee Information
a. Fun Name
e. ID Number
CQ,r
IL Mailing Add (include City, State and lip Code)
it. Date organized
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Phone Number
. Candidate Information Candidate's Primary Committee
. Full
Candidate ID Number
r. Party Amustion
�Name
p�a
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(hMicate partisan if applicable)
. hailing Address(include City, Stateand tip Code)
g. Office Sought
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. Phone Number
1�3.
it. Email Address
h. Next Election Yissr
1L Jurisdiction
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Email copy of notices
Treasurer Information
4. Custodian of Books Information
a.
a. Full Name
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P. Mailing Address (include City, StatA and tip Code)
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L Mailing Address (include City, Stat%and Trp Code)
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Phone Number
Id. Email Address
eFhone Number it. Email Address
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I refer to receive notices b email Yes No
Email co of notices
. Assistant Treasurer Information UAdd
. Full Name ❑ Remove
6. Account Information Owt CRO -3500)
L3 Add
❑ Retoow
a. Financial Institution Full Name
hL Mailing Address (include City, State, and Zip Code)
D. Purpose
Phone Number
d. Email Address
Account Code
it. Type
Email co of notices
ERTIHCATION
1 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.
1 further certify that this report is complete, true and correct.
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Printed Nameof igner ignafure ofAppoin. serer Due
CRM27nnd
July 2011
DD
6 2019
Elections
"VOITl NORTN CAROLINA
STATE BOARD OF ELECTIONS
Certification of Threshold
This Certification is used to declare or withdraw a committee's intent to raise or spend $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)
Treasurer Phone:
Ca -r<< �ar
(:104)"534- 2St12
M
JUL 2 6 2019
he One:
!V111
certify that this committee intends to neither receive nor 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 fiI II future reports required.
Date Skmd Signator
CRO -3600 Certification of Threshold
D
u
D
VOTE
NORTH CAROLINA
STATE BOARD OF ELECTIONS
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 filed at the Board of Elections office where the committee's campaign reports
are filed.
FILED BY:
Candidate Name:
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
Treasurer Phone:
I certify that the above information is correct, and 1, 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).
Date Sigi d signature of
CKO-3100 Certification of Ireasnrer
NORTH CAROLINA
STATE BOARD 'OF ELECTIONS
I Certification of Financial Account Information I
This Certification is used to report confidential bank account information for all financial accounts
established by the committee and must accompany the Statement of Organisation Form.
FILED.BY:,
Committee Name: er 5
Treasurer Name:,5 t)-t.JA
Treasurer Address: $ tb 2 61
(include city, state, & zip) VA1174
Treasurer Phone: (- DM6Z
I certify that the information provided below is true and'accurate. 'I am providing all account information for the above
named Committee. Theseaccount-numbers include all bank accounts utilized, credit card accounts, money market or
savings accounts, or any other financial account used for any purpose by the Committee.
The information provided on this form is considered confidential and is not subject to public disclosure. The information
provided is only used for the purposes of an audit or investigation or as required by a court of competent jurisdiction.
numbers and letters) by which to refer to the account number on redorts. If an account number is used as the "account
code," confidentiality of the account number is presumed to have been waived.
The treasurer. shall maintain all moneys of the political committee In a bank account or bank accounts used exclusively by
the political committee and shall not commingle those funds with any other moneys.
Tvne ofaecouot Financial Institution Address
Account Number Account rnde
C xL :r
cT %
bo 1 it on F I
CUI
I
By signing )is statement, I Authorize agents of the State Bo f ctions.F •in9pect all accounts provided.
Date igned Signature of C-m-di4bie or Treasurer
For Candidate Committees Onlv
❑ In lieu of providing account information, I certify that this committee will not raise any money nor spend any money
except that which is the candidate's personal funds. I furthermore understand that an audit or investigation could
warrant the probe of any personal bank account that is being used for campaign expenditures.
By signing this statement, I authorize agents of the State Board of Elections to inspect applicable accounts.
Date Sigred Signature of Candidate or Treasurer
CRO -3500 Certification of Financial Accountlnformation