Kerr, James_2021-Stmt-of-OrgI bA
Statement of Organization - Candidate Committee Is is statement.
New ElAmended
Use this form to create a new or update an exiskniLcandidate committee.
This form must be accompanied by fo CRO-35QAn amended form is required for each new election year.
1. Committee Information
a. Name of Committee
Yf (3 CUJ�CI I
d. to Number
b. Mailing Address (include City, State and Zip Code)
e. Date Organized
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. Committee Website (Optional)
f. Phone Number
2. Candidate Information
a. Full Name _
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e. Party Affiliation
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b. Mailing Address (include City, State, and tip Code)
f. Office Sought
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. Phone Number
d. Email Address
g. Next Election Year
It. Jurisdiction
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ounc;iV</, cw�ts� c4"r
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12 Email COPY of report notices MU
3. Treasurer Information
4. Assistant Treasurer Information
a. Full Name
a. Full Name
UNIOGN RNANCE
SOAK WAVIOe- KAPELhK
. Mailing Address (include City, State, and Zip Code)
In. Mailing Address (include City, State and Zip Code)
114 K . CE+dRCA :tlrI'I cEr
8112cMOKRoE, KC Z8117-
AUG
. Phone Number
c.
Id. Email Address
c. Phone Number
d. Email Addre
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Send report notices by email E3 Yes No
Email copy of report notices
5. Custodian of Books Information (Keeper of Records
6. Account Information (inti. CRO -3500)
a. Full Name
'�Olim WhLTE9_ KAPELAK
a. Financial Institution Full Name
&AKK
. Mailing Address (include City, State, and Zip Code)
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PnoOROE , P[C 281 1 q -
c. Number Id. Email Address
b. Account Code
1c. Type
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JoA283-8185 larSK338"1
0 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 App inted 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 mqtsurer and subject to the penalties in Article 22A of Chapter
163 of the NC General)Saes
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PrintedN of Candidate Signature of Candidate D
CRO -1100A
CNC State Board of Elections
November 2019
PTH CAR
: 11
ELECTI
I 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:
uh a�
Treasurer Name: John W. Kapelar UNION i F "' -
4APA1 1
CE
Treasurer Address: 114 N. Church Street AUG 9 It 1
(include city, state, & zip) Monroe, NC 28112
Treasurer Phone: 704-283-8189 REGEVVED
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 desienate below an account code Jany 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
Simple Checking American Bank
Account Number Account Code
tj
By signing this statement, I authorize agents of the State Bosrd of Elections to inspect all accounts provided.
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Date Signed Signa re of Candidate or Treasures
For Candidate Committees Only
=J 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.
By signing this statement, I authorize agents of the State Board of Elections to inspect applicable accounts.
Date Signed Signature of Candidate or Treasurer
CRO -3500 J Certification of Financial Account Information