Helms,Brian_2022-!-Stmet-of-Org-amendStatement of Organization - Candidate Committee Is this statement:
❑ New ICJ 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 forni is required for each new election year -
1. Committee Information
a. Name of Committee
J.In Number
'Ba:IItJ r0a HIS Q.
b. Malting Address (include City, State and Zip Code)
_
e_. Date Organized
1421 'Ot. oncce n1C t
2/2s/2o22
c. Committee Website (Opdonal)
-- — -
f. Phone Number
-
ogoi 21q • 043S
2. Candidate Information
a. Full Name
e. Party Affiliation
NOW films
b. Mailing Address (include City, State, and Zip Code)
f. Office Sought
1421 -gteAolcy t�R.61OAjof, /�_ 28112
ODOAMcss:dnere
c. Phone Number I d. Email Address
g. Nest Election Year
h. Jurisdiction
(480 219-o43S bheWrets` MA4.(,an'1
I'.Illall co pVof 1'e X111 I1011c"
3. Treasurer Information
4. Assistant Treasurer Information
a. Full Name D'
/ n
a. Full Name
b. Mailing Address (include City, State, and Zip. Code) _
910fe0w
b. Mating Address (include City, State and Zip Code)
Oc
({l64
98(1-3
e. Phone Number
1h. Email Address
c. Phone Number
d. Email Address
I4�4w
maha--Mid.usa@ w+a,l.I
KA
Send report notices by email Yes ❑ No
LJ Email co v of report notices
5. Custodian of Books Information (Keeper of Records
6. Account Information (ind. CRO -3500)
a. Full Name - tttv}eN ems
_—
a. Financial Institution Full Name
-
CAMPAIGN FINANCE
b. Malang Address (include City, State,Code)
e,fatnd
ftC2�e
c. Phone Number
d. EiVEE)It.
Account Code
1c. 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 prohib'ted or disclosed funds. 1 further certify that
t s [eport iii complet , e app Erect.
ars a. 61
03 os;W;
Printed Name of Treasurer N156ature
Appointed Thtlisurer Date
1 certify that the information above is correct, and 1, as the candida e, 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 Statutes.
riiaa l�oa t IF.IMS
' n
. z 315/v,24
Printed Name of Candidate _��"
Signature o Candidate Date
CRO -2100A NC State Board of Elections November 2019