Kamolnik,Colleen_2022-CommitteeStatement of Organization - Candidate Committee I Is this statement:
LJ!L Ne" ❑ Amended 1
Use this form to create a new or update an existing candidate committee.
This form must be accom anted by form CRO i-3500. An amended form is required for each iii v election year.
CRO -2100A NC State Board of Elections November 2019
n. Name of(nuuniore
Coofen kAmolnikhy BoEDisty1c-I- 1
d.IU Nu_mhIer
t"AIV)
b. Mailing Address (include City, State and Zip Code)
e. Date otlaulm
121 A (/h e Ln I Morin(, N(-,
_
28112
02102,120z2
C. Committee Website (Optional)
L Phone Number
l tx-f 2q to N5 b+
2. Can .Information
. Full Name
Collet✓► M"BylA2 KAM01rilk
e. Party Affiliation
Ree u6111WI
. Mailing Address (include City, State, and Zip Code)
L Office Sought
-12t il't'chle Lrl
W Vj VVP, PC. 2.8112
LAh ton Counhy Boar of Fr4ua Lttal
0%StV%C,4 ►
. Phone Number I
d. Email Address
. Next Election Year
It. Jurisdiction
104z4e4str
Cat►etrt%#-&E'1@ tl•cnn
2022
union Court
Email co of reori notices
so
. Full Nate
4. Assistant Treasurer information
a. 1 ull Namr
CoIkG+1 6uhmoll-ilk-
oln
b. . Mailing Addrees (1ucCude City, 9tafa, and Zip Code)
b. Mailing Address (include City. ate lr n n I /.i p 1 1,1
—121 A -T -C %11 •r: Vn
MDA WC , N c- IC112-
c. Phone Number
-104
2gto 4_S(04
it. Email Address
c. Phone Number
d. Email Address
Coll fen FOVI El-@9ntil,LCam
Sent] re ort notices be crnail Ye, 5..
F,mail co ofre ort notices
5. Custodian of Rooks Information Kee er of Records
6. Ae rata (incl CRO -3500)
. Full .Name
Colle-evl M c uric. KAvvvD 0(k
a. Financial Institution F'uli Name
. Mailing Address (Include City, State, and Zip Code)
LU u.
i2.( AYtvt if i ✓/
rnon vvt NC Zg) t Z
. Phone Number d. Email Address
b. Account Code
lvglqu 4 9&4 1 CoileenFor W I -E0 I .
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 ' F i ited or other non -disclosed funds. I further certify that
�is report is complete, true d correct.
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Printed Name of Treasurer Signature of Appointed Treasurer Date
I certify that the information above is correct, and I, as the candidiate, appoint said treasurer to personally fulfill the
duties and responsibilities imposed upon the appointed Fd sub' the penalties in Article 22A of Chapter
163 of the NC General States. I,
ro IULO VPCJ nd� �'Ur%t( 21 u�zy
Printed None of Candidate Signature of Candidate Date
CRO -2100A NC State Board of Elections November 2019
2M
VOTE
NORTH CAROLINA
STATE BOARD OF ELECTIONS
Candidate Designation of Committee Funds
This fort is used by candidate committees only and allows the candidate to designate in the event of their death,
how the committee's funds are to be disbursed using the eight allowable methods outlined in 163-278.16B(a).
This Designation is filed at the Board of Elections
office where the committee's campaign reports are filed.
((
Candidate Name: l DIWA �C i0hOL UM01jl(k—
Committee Name:
Treasurer Name:
If Candidate is own treasurer, designate an agent to carry out designations: Dn I u f W 111yi S
Committee ID #:
Level Registered: [State] [County] If county, specify: Ulm W U nhA
I,C01k X1 M ►N (4 ij VMM IJI hereby direct that in the event of my death or incapacity all
(Name of Candidate)
funds remaining in my Campaign Committee account(s) (after payment of permitted outstanding
debts or reasonable expenses for winding up the Committee or closing office) be paid in the
following manner as permitted by N.C. Gen. Stat. 163-278.16B(a).
Name of Entity Plan for Disbursement (ea. Amount or %)
(Selee(from §163-17&16B(a))
I.&I nCoudiu GOP 10C),1-
2.
3.
By signing this form, I certify that the foregoing entities are eligible beneficiaries under N.C.
Gen. Statute 163-278.16B(a). A c this form should be maintained with the Committee
records.
UNION COUNTY
Signature of Candidate: CAMPAIGN FINANCE
Date: II 22- FEB 11 2022
RECEIVED
CRO -3900 Candidate Designation of Committee Funds