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Baer,Jonathon_2019-CommitteeStatement of Organization - Candidate Committee 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 amendine Amendment ❑ Yea ❑ No only re -submit if applicable) 1. Committee Information . Full Name c. ID Number L-11 v1/ 3 N . Mailing Address include City, State and Zip Code) d. Date Organized ,S61-1 Raps Rd), II in� �at� s�1f i ncGOW f-aiI I IV` aVv� 1 e. Phone Number qBo. a8g- 2. Candidate Information []Candidate's Primary Committee . Full Name e. Candidate m Number If. Party Affiliation JDnREhIXI �'� aP,r ; (brdicate Non-partisan if applicable) b. Mailing Address (include City, State, and Zip Code) g. Office Sought 551 �s I I 1� ale TAI . Phone Number d. Email Address h. Next Election Year t. Jurisdiction notices �DY1'I ❑Email copy of no Ens " ' I 1 . -Treasurer Information 4. Custodian of Books Information . Full Name a. Full Name .J . Mailing Address (include City, State, and Zip Code) b. Mailing Address (include City, State, and Zip Code) I a Via( ( 0 C_ 7q Number d. Emai Address a Phone Number d. Email Address %..��Phhone -ISO. 00 . G I , CJI�I 1 refer to receive otices by email Yes Lj No ❑ Email copy of notices 5. Assistant Treasurer Information Add 6. Account Information (incl. CRO -3300) Add ❑ Remove . Full Name ❑ Remove a. Financial Institution Full Name b. Mailing Address (include City, State. and Zip Code) b. Purpose �L JUL 19 2019 . Phone Number d. Email Address c. Account Code d. T pe neon Co. Elections Email copy of 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. I further certify that this report is complete, true and correct. �onaihon�l�r 7-f -1 Printed Name of Signer 6,11gnature of Appoi led ensurer Date CRO -1100A NC State Board of Elections July 2011 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 $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: qW - oq6 TChec One: 1 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 approp board of elections and file required campaign finance reports. THIS DECLARATION CAN ONLY BE MADE AT THE BEGINNING OF AN ELECTION CY I am withdrawing my Certification to remain at or under the $1,000 threshold. I will now b requdAL 19 2019 to file the next scheduled report for all contributions and expenditures that have not been r iqusly reported from the beginning of the current election cycle. I further agree to file all future reports r I1 Co. Electi( Date Signed Si t ( KO -3600 ('edification of7hreshold PTE NOPTH 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 a here the committee's campaign reports are filed. FILED BY: Candidate Name: Treasurer Name: 'Sc4ee Treasurer Address: Ssn l2a S (include city, state, & zip) 'I� (�� ((Tb q Treasurer Phone: 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 V111. 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 tressEthe the existing Statement of Organization within 10 days of the vacancy. 1 further understand019 Treasurer is required to receive training by the State Board of Elections within three montappointment according to Article 163.278.9(k). CtIODS Dale Signed Signature of ndid CRO -3100 Certification ofTreasurer- © NORTH CAROLINA VOTE r1TT� STATE BOARD OF ELECTIONS Confidential Certification of Financial Account Information This Certification is used to report confidential bank account information for all financial accounts established by the committee and must accompany the Statement of Organization Form. FILED BY: Committee Name: L -,D �U7 f0✓) Treasurer Name: rl J&,f Treasurer Address: I Qf-s Qt4 (include city, state, & zip) =✓IGt,0L,1 (,at 1 Treasurer Phone: q 10. g r. QY6 1 certify that the information provided below is true and accurate. I am providing all account information for the above named Committee. These account 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. Each treasurer (or candidate) must designate below an account code (any number or letter or combination of numbers and letters) by which to refer to the account number on retorts. 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. Type of account Financial Institution Address Account Number Account Code By signing this statement, I authorize agents of the State Board of Elections to inspect all accounts provided. Date Signed Signature of Candidate or Treasurer For Candidate Committees Only 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, 1 authorize agents of the State Board of Elections L inspect ap licable accounts. Date Signed tatureof Candida C�GML�D JUL 19 2019 CRO -3500 Certification of Financial Account Information Union Co. Elections