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Kindley,Patricia_2021-Committee
Statement of Organization - Candidate Committee Is his statement: New 13 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 form is required for each new election year. 1. Committee Information a.Name of Committee d. ID Number 1 _ A i G CO M Wti a b. Mailing Address (include Cit tc and Zi Code) ; S - e: Date Organized I l08o' o J vi oe- G 8 l0 h to J,( c. Committee Website (Optional) EENumber /Phone t 0q [y!S Iva 2. Candidate Information a. Full Name a—Party Affiliation .. 1 'SMI CI VI C- b. Mailing Address (include City, State, and Zip Code) f. Office Sought q u0$ UAZONJ t lle- %/V", eN RIA . mo & ul_« 1 c. Phone Number d. Email Address g. Next Election Year h. Jurisdiction 404) q _ klhdl w.0.tl•coWl �p 2 1 ❑ Email copy of report notices 3. Treasurer Information 4. Assistant Treasurer Information a. Full Name a. Full Name '00"?, 0AVII, ab b al b. Address (include City, State, and Zip Code) b. Mailing Address (include City, State and Zip Code) fMt la1d�ling I'tt� F.V'lt�y !eL Eas+ II oAV'02 c Pho a Number Id.EmailAddress c. Phone Number Id. Email Address .� g_ 5 a1�c�ltabinalS5Ca marl- w, Send report notices b email Ycs No LJ Email copy of report notices 5. Custodian of Books Information Kee er of Records 6. Account Information (incl CRO -3500) n. Full Name a. Financial Institution Full Name UNION COUNTY b. Mailing Address (include City, State, and Zip Code) JUL. 2 9 2021 c. Phone Number Id. Email Address b. Account Code c. T y p'1RA ❑ 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 ther non -disclosed funds. I further certify that this report is complete, true and correct. NtceH.i}A6, JAt4n 7a6al Printed Name of Treasurer Signature Iff Appointed Treasurer D to I certify that the information above is correct, and 1, as the candidate, 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. V42 V a Printed Name of C lote Signature of Candida Dat CRO -2100A NC State Board of Elections — November 2019 VOTE © NORTH CAROLINA STATE BOARD OF ELECTIONS Confidential