Greene,Sandra_2022-CommitteeStatement of Organization - Candidate Committee Is this statement:
❑ New ❑ Amended
Use this form to create a new or update an existing candidate committee.
This form mast be accompanied by form CRO -3500. An amended form is required for each new election year.
I. Committee Information
a. Name of Committee
d. ID Number
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b. -Mailing Address (include City, State and Zip Code)
e. Date Organized
. Committee Websit (Optional)
f. Phone Number
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2. Candidate Information
a. Full Name
e. Party Affiliation
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b. Nailing Address (include City, State, and lip Code)
f. Office Sought
c . Phone Number
it. Email Address
g. Neat Election Year
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h..lurisdietion
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❑ Email copy of report notices
3. Treasurer Information
4. Assistant Treasurer Information
a. Full Name
a. Full Name
. Mailing Address (include City, State, and Zip Code)
b. Nailing Address (include City, State and Zip Code)
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. Phone Number
it. Email Address
c. Phone Number
d. Email Address
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Email co of re ort notices
5. Custodian of Books Information (Keeper of Recordsl
6. Acco (mel. CRO -3500)
a. Ildl \amea.
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b. Mailing Address (include City, State, and Zip Code)
RECEIVFF)
c. Phone Number
it. 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.
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Printed Name of Treasurer �� Signature of Appointed TreasutEr Date
I certify that the information above is correct, and I, a candidate, appoint said treasurer to personally fulfill the
duties and responsibilities imposed upon the appoint
er and subject to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
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Printed Name of Candidate
Signature of Candidate Date
CRO -2100A NC State Board of Elections November 2019