Gilliard,Crystal_2019-StmtOfOrgStatement of Organization - Candidate Committee Is this statement:
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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 vear.
1. Committee Information
a. Name of Committee
d. ID Number
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b. Mailing Address (include City, te and Zip Code)
e. Date organized
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. Committee Website (Optional)
E Phone Number
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2. Candidate Information
a. Full Name
e. Party Affiliation _
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b. Mailing Address (include City, State, and Zip Code)
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. Phone Number
d. Email Address
g. Neat Election Year
h. Jurisdiction
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O Email copy of rel lotices
3. Treasurer Information
4. Assistant Treasurer Information
. Full Name
a. Full Name
b. Mailing Address (include City, State, and Zip Code)
b. Mailing Address (include City, State and Zip Code)
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c. Phone Number
d. Email Address
c. Phone Number
d. Email Address
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Send report notices by email L3 Yes No
U Email copy of report notices
5. Custodian of Books Information (Keeper of Records
6. Account Information (met CRO -3500)
a. Full Name
a. Financial Institution Full Name
b. Mailing Address (include City, State, and Zip Code)
. Phone Number
d. Email Address
b. Account Code
e. Type
El 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.
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Printed Name of Treasurer Pignature of Appointed Treasurer Date
I certify that the information above is correct, and I, 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 General StatyU P.
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Printed Name of Candidate k Signature of Candidate Date
CRIB -2100A NC State Board of Elections November 2019
(VOTE NORTH CAROLINA
*'STATE
BOARD OF ELECTIONS
UNION COUNTY
CAMPAIGN FINANCE
JAN 31 2020
Confidential RECEIVED
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: Crystal Gilliard ROD Campaign
Treasurer Name: Crystal D. Gilliard
Treasurer Address: 2721 Long Hope Road
(include city, state, & zip) Monroe, NC 28112
Treasurer Phone: 704-361-0606
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 reports. 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.
Tvue 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
El 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.
signing this statement, I authorize agents of the State Board o flections to n nlspect applicable
01/1/ Qa �p`Y-�-31/2020 tt/lJ
Date Signed 3ignature of Candidate m Treasurer
CRO-3500 Certification of Financial Account Information
vol NORTH CAROLINA
STATE BOARD OF ELECTIONS
Certification to Return to Active Status
This Certification is used by Candidate, Party, PACs and Referendum Committees which have previously
filed the Certification of Inactive Status and now wish to return to an active status.
This Certification is filed at the Board of Elections office where the committee's campaign reports
are riled.
FILED BY:
Committee Name: 1 t911 i(r6L R O In `gawm i t)
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
Treasurer Phone:
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I certify that the above named candidate/political committee, which has been of inactive status and exempt
from filing disclosure reports, intends to accept contributions and/or make expenditures. This intention of
activity alters the status of the above named candidate/political committee to active status and requires
such committee to begin filing disclosure on the appropriate schedule. All contributions received and/or
expenditures made that have not been previously reported will be disclosed on the next scheduled report
and all subsequent reports will be filed as scheduled. An amended Statement of Organization (CRO -2100
A -G) must accompany this form.
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,.Signature
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CRO -3300 Certification to Return to Active Statas