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Callis,Elizabeth_2019-Committee-formsStatement of Organization - Candidate Committee Use this form to create a new or update an existing candidate committee. .[mendment ❑ Yes ❑ No . Full Name r. ID Number Elizabeth Callis for Mayor b. Mailing Address (include City, State and Twp Code) d. Date Organized 1675 Cox Road JUL 0 5 2019 7/5/19 Waddington, NC 28104 Union Co. Elections a Phone Number ,. Fuss Name Elizabeth Callis . Mailing Address (include City, State, and Zip Code) 1675 Cox Road Waddington, NC 28104 . Phone Number d. Emaa Addreee 704-814-0525 Ecallis@townotweddington.com. ❑Email copy of notices . Treasurer Information a. Full Name Elizabeth Callis b. )1:, fling Address (include City, State, sad Zip Code) 1675 Cox Road Weddington, NC 28104 . Phone Number d. Email Addreas 704-814-0525 Ecallis@townotweddington.com I prefer to receive notices by email Ll Yes 704-814-0525 Candidate 11) Number E Party Affiliation Non -Partisan Office Sought Mayor Year IL Jmiadietion 2019 i. Full Name Elizabeth Callis t. MaWmg Address (iaelulle City, State, and Lip ( ode) 1675 Cox Road Waddington, NC 28104 Phone Number d Email Address 704-814-0525 Ecalllis@townotweddington.com 5. Assistant Treasurer Information U Add 6. Account Information (incl CRO -3500/ JU Add ,. bull \ams ❑ Rcmove a. Financial Institution Full Name JU Remove Truliant Federal Credit Union D. Matting Address (include City, State, and Zip Code) & Purpose Campaign Finance :. Phone Number Id. Email Address . Account Code Id. Type EC I Checking 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 ftmds. I further certify that this report is complete, [rue and act 1 4114 rin. Elizabeth Callis 7/5/19 Printed Name of Signer ature of Appoimed T urer Date 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: Elizabeth Callis for Mayor Treasurer Name: Elizabeth Callis Treasurer Address: 1675 Cox Road (include city, state, & zip) Weddington, NC 28104 Treasurer Phone: 704814-0525 hG 15w- e: — I 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. 163-278.1OA. 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 TIME 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. Ifurther gree to file all future reports re uired. I 7/5/19 4E AZ Date Signed Sipnazute CRO -3600 Certification of Threshold 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: Elizabeth Callis Treasurer Name: Treasurer Address: (include city, state, & zip) Treasurer Phone: Elizabeth Callis 1675 Cox Road Weddington, NC 28104 704-814-0525 Union U0. 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 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 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). 751q Date Signed Signature of Candidate CRO -3100 Certification of Treasurer 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: Elizabeth Callis for Mayor Treasurer Name: Elizabeth Cailis Treasurer Address: 1675 Cox Road (include city, state, & zip) Waddington, NC 28104 Treasurer Phone: 704-814-0525 I 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 reoorts. 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 Checking Truliant Credit Union 7107 Waverly Walk Way Char. NC EC By signing this statement, I authorize agents of the State Board ooffy�l n lectiot inspect all a un provided. 7/5/19 ;- //L � Daze 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, I authorize agents of the State Board of Elections to inspect applicable accounts. Date Signed Signature of Candidate or Trea = CRO -3500 Certification of Financial Account Information 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 filed at the Board of Elections office where the Candidate Name: Committee Name: Treasurer Name: Elizabeth Callis Elizabeth Callis for Mayor Elizabeth Callis If Candidate is own treasurer, designate an agent to carry out designations: Janice Prospt Committee ID #: Level Registered: union gt [State] [County] If county, specify: I Elizabeth Callis hereby direct that in the event of my death or incapacity all (Name of Cm&dme) 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 Entity (Select from §163-278.16B(a)) I Town of Weddington `4 Ri Plan for Disbursement (eg. Amount or %) 100% 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: Date: 7/5/19 Candidate Designation of Committee Funds