Bention,Jimmy_2021-CommitteeStatement of Organization - Candidate Committee .1eW [3 Amended this statement:
Use this form to create a new or update an existing candidate committee. n7
This form must be accompanied by form CRO -3500. An amended form is required for each new election year.
1. Committee Information
a. Name of Committee
d. ID Number
CC m i Hec-4 kity.
Is. Mailing Address include City, State and Zip Code)
e. Date Or anized
3G:L TyCker 54tesl FrllorijnoiL,Atc
_ _
XV1101119u.
�CovZ
c. Committee website (Optional)
r. Phone Number
7C -57a QP ZX'
2. Candidate Inlbrmation
a. Full NJnle
f. hal'tY.rilihati.],
1 !*ASr.
R eu b IC 0..
It. Mailing Address (include City, State, and Zip Code)
I. Office Sought
30a- Iuc liar $+r`ee.+
VAICn. r— —C4, }Ye /VG
P)oAit, o'e- fV c ap It o
SchoolBack-4 A+ Lo-rSc-
c. Phone Number
it. Email Address
g. Next Election Year
Ili, Jurisdiction
7(-4 -S Iz oP
.I
I in,lt, c
:7JZC
Un; C. (- }
❑ Email copy of report notices C oma.
3 Treasurer Information
4. Assistant Tr9asugr-ijillormation
a. Full Name
a. Full Name -
b. Mailing Address (include City, State, and Zip Code)
b. Mailing Addres (include Clty, tateiii Ziip C e)
3o3- Tuc HC ree+
Union
(; _I1-Ct10ns
m e /VC- �1 I o
� �-
c. Phone Number
d. Email Address
4imft%Ykbe,..+;cnS�
c. Phone Number
d. Ema it Address
704-
5 7a- Os
-%� .
Send report notices by email 61Vcs 0 No
D Email copy of re port notices
5. Custodian of Books Information (Keeper of Records
6. Account Information ; (incl CRO -3500)
. Full Name
a. Financial Institution Full Name
wells FcLt-gc>
It. Mailing Address (include City, State, and Zip Code)
. Phone Number Id. Email Address
Ili. Account Code
c. Type
0 y
C 6 e c K i t1
❑ Email copy of report notices
I 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.
La.4o ad L. Bern +ion.
Printed Name of Treasurer
Signature of Appointed Treasurer Date
I 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 of the NC Generalr�z(atutes.
�1.�
aTmr•ty • t3 ;&v1. Sr.
i4itted Name of Candidate
Signature of Candid Date
CR0-2100A VNC State Board of Elections November 2019