Kirkpatrick,John_2022-!-SOOStatement of Organization - Candidate Committee
Use this form to create a new or update an existing candidate committee.
Is t 's statement:
New ❑ Amended
i its tonin must be accompamea by term Lieu-O.�UII. An amenaca term is regmrea Tor each new election year
I. Committee Information
a. Name of Committee d. ID Number
. Mailing Address (include City, State and Zip Code) _ e. Date Organized
D. as a- G ► 1 3I a - a --a,
c. Committee Website (Optional) E Phone Number
AT Name
b. Mailing Address (include City, State, and Zip Code)
,u�
AA. 0 - o� 2-T& 2-
Moo v ♦ e, 2.$f 1
c . Phone Number it. Email Address
qiO* 2 --,to-:- John K: .
a. Full Name
'� 'YOrtn t- Saal �
b. Mailing Address (include City, State, and Zip Code)
2-18 3 3 . Ok'J 52 d
1`4ars4t ✓Z lLc, t\(G. 28 (03
c. Phone Number Id.EmailAddress
Party Affiliation
Abe ry1pc►ra, l � c�
Office Sou -11t
Next Election Year Is. Jurisdict
aoaa ask
Assistant Treasurer Information
Full Name
Mailing Address (include Citv. State and 7
Phone Number --1d. Email Address
Code)
040-
00. ggy3
Send report notices by email O Yes No I Ll Email conv of report notices _...
a. Ful Name
J,)Il ft4e, Sow -
aili_ng Address (include City, State, and Zip Code)
(z -its 73 Aaiyl� 9-a .
M a r9nv.' I lt., 1`1 (, )-g 163
. Phone Number it. Em it Address
94oUgc a au -+t WIC C.
Email copy of reptithicitices
I certify that the Committee is in compliance with all
General Statutes and that no funds are commingled w
thisre ort is complete, true and correct.
0 E. 1 q av, N
Printed Name of Treasurer
I certify that the information above is correct, and I, as
duties and responsibilities imposed upon the appointed
163 of the NC General Statutes. n
Printed Name
Financial Institution full Name
F-9 UT<7l
MAR 11 2022
RECEIVE
b. Account Code c. Type
" K 12.:,, QI --
ilicable provisions of Article 22A of Chapter 163 of the NC
prohibited or other non -disclosed funds. I further certify that
Si amsu r re of Appointed Treat�
can 'date, appoint said treasurer to personally fulfill the
as and subject to the penalties in Article 22A of Chapter
ignatureo andidate Date
n.w.a ..r GL...N..ee 1J........6a. 9nlo
nNORTH CAROLINA
STATE BOARD OF ELECTIONS
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)
J 5 K 1 rune.
Treasurer Phone: 54-0 • b`-� L-. t--Kj 4
Ch k One:
I certify that this committee intends to neither receive nor expend more than $1,000 during the current
election cycle under the procedures set forth in G.S. 163-27$.1 OA. 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 furthef agree to file all future reports required.
Data Signed
CRO -3600
Certification of Threshold
UNION COUNTY
CAMPAIGN FINANCE
MAR 11 2022
RECEIVED