Hamill,Gary_2017-CommitteeStatement of Organization - Candidate Committee
Use this form to create a new or update an existing candidate committee.
This form must be accompanied be forms CRO -3100 and CRO -300 (when amendine
Amendment 1--1
❑ N" is No
onk re -submit it applicable).
1. Committee Information
. Full Name
GaRY
c. ID Number
. Mailing Address (include ( itv, State and Zip Code)
/ Q 5 Mari an 01 a CIA
/Vc }4
gi
d. Date Organized
e. Phone Number
404-161-1wll
2. Candidate Information andidate's Primary Committee
. Full Name
GA Qy FtR t ��-
c. Candidate ID Number
f. Party Affiliation
(Indicate Nonpanisan if applicable
b. Mailing Address (include City, State, and Zip Code)
g. Office Sought
. Phone Number
d. Email Address
h. Next Election Year
ILJurisdiction
9-04-101411
01014
mail copy of notices
. Treasurer Information
4. Custodian of Books Information
a. Full Name
GARY } L`
a. Full Name
b. \tailing Address (include City, State, and Zip Code)
b. Mailing Address (include City, State, and Zip Code)
/05 Marlatnna Cutilo
M ilia i } 4
. Phone N ber
Id. Email Address
c. Phone Number
Id. Email Address
I refer to receive notices b • email es No
Email co of notices
S. Assistant Treasurer Information Add
. Full Name JU Remove
6. Account Information Earl. CRO -312L) Lj Add
a. Financial Institution Full Same ❑ Remove
b. Mailing Address (include City, State, and Zip Code)
It. Purpose
. Phone Number
d. Email Address
c. Account Code
d. Type
Email co of notices
CERTIFICATION
1 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 funds.
I further certify that this report is complete, true and cc
t-+Mtt_� �f t I Irt
Printed Name of Signer Signature of pointed Treasurer Date
CRO -2100A SNC State Board of Elections July 2u I I
North Carolina
State Board of Elections
441 N Harrington Street
Raleigh, NC 27603
Kim Westbrook Strach
Executive Director
Mailing Address
PO Box 27255
Raleigh, NC 27611-7255
(919) 733-7173
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:
Treasurer Name:
Treasurer Address:
(include city, state, & zip)
GgRy ++" t LL-
Treasurer Phone: w 4 — w` f t4 11
Ch One:
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. 163-278.10A. 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 THE 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. I further . e to file all future reports required.
Date Signed Signature
CRO -3600 Certification of Threshold July 2014
Kim Westbrook Strath
Executive Director
North Carolina
State Board of Elections
441 N Harrington Street
Raleigh, NC 27603
Certification of Treasurer
Mailing Address
PO Box 27255
Raleigh, NC 27611-7255
(919) 733-7173
This Certification is used by Candidate Committees to appoint a treasurer to the committee. This form is
required and must accompany the Candidate's Statement of Organization
FILED BY:
Candidate Name: G Af-I �4prm i LL-
Treasurer
_LTreasurer Name: Goal "AAA I I (
t
Treasurer Address: 105 Mr tzn n q CylEh
(include city, state, & zip) N
Treasurer Phone:
I certify that the above information is correct, and I, 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 V/!L Regulation ofElection 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).
Daze Signed Sign re of andidate
Note: This Certification is to be filed at the Election Board where the committee's campaign reports are filed.
CRO -3100
Certification of Treasurer
July 2014
North Carolina
State Board of Elections
941 N Harrington Street
Raleigh, NC 27603
Kim Westbrook Strach Mailing Address
Executive Director PO Box 27255
Raleigh, NC 27611-7255
(919) 733-7173
Confidential
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: GAky (+O M ( LL
Treasurer Name:OW LL
Treasurer Address: 10Y /KGt/?ac
(include city, state, & zip) NC �� 4
Treasurer Phone: Q -q62 'Q4 I
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.
Type 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 Comrnittees 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 c sign expenditures.
By signing this statement, I authorize agents of the State Board o tions to inspec app ' ab ccoun[s.
I—
('t T
Date Signed Signatu f Candidate or Treasurer
CRO-3500 Certification of Financial Ac int Information Jidv 2014