Elam,Edwin_2021-CommitteeStatement of Organization - Candidate Committee ist s statement:
New ❑ Amended
Use this form to create a new or update an existing candidate committee.
This form must be accompanied by form CRO -3500. An amended form is required for each new election year.
i. Committee Information
. Name of Committee
d. ID Number
C--dW( n L� rA rYN �o CsSU a�� Cent m13S40 fJP d
. Mailing Address (include City, State and Zip Code)e.
ate Organized
IDo W vJ P (2 V IJP, - '23
�A RIJ nit gl 3 10/. 6 4,
C. Committee Website (Optional)
--
f. Phone Num'her
- 7QY-Y7)=G5Y
2. Candidate Information
a. Full Name
cplzmol E
e. Party Affiliation
RtReullC a
b. Mailing Address (include City, State, and Zip Code)
A6 W00fkA)L *Cj<W AY - / Z3
WAAk Ate ..1C /
E Ottiee Sought
UN/er1 Coudf C4,~-t35f%J4Z$
c . Phone Number
it. Email Address
g. Neat Election Year
h. Jurisdiction
%'Y Stas
rtoA,►t
--Aa2Z
Un/,cAC„u.f}7NC
❑ Email co of report notices
3. Treasurer Information
4. Assistant Treasurer Information
a. Full Name
V)"'ISICLk/ V-X)VO,14��V5
a. Full Nam,
b. Mailing Address (include City, State, and Zip Code)
Is. Mailing Address (include City, State and Zip Code)
PO 60X 7C? 06T
Cat otnl o -H e N C 292-4 L
. Phone Number
-3ZS-o22o
d. Email Address
c. Phone Number
d. Email Address
Vt"LACnCL
Send report notices by email iff Yes ❑ No
Email copy of report notices
5. Custodian of Books Information (Keeper of Records
6. Account information fiacl. CRO -3500)
a. full Name
a. Financial lnstift@4Vt&NtW1 y
1PAIGN FINANCE
b. )tailing Address (include City, State, and Zip Code)
DRU 2021
RF IVED
c. Phone Number
d. Email Address
b. Account Code
c.Type
❑ 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.
Vied Koynle.-lSRV l/` _— /2/)6/202.
Printed Name of Trcasmufr Signature of Appointed Treasurer Date
I certify that the information above is correct, and I, as the candidate, a' t s 'd treasurer to personally fulfill the
duties and responsibilities imposed upon the appoin dt ea�a urer a Wt toa penalties in Article 22A of Chapter
163 of the NC General Statutes. r
TZCI tA.)1 r e (A4 M 1
Printed Name of Candidate Signature of Candidate ate
CRO -2100A NC State Board of Elections November 2019