Lein,Jamie_2019-OrgStmtStatement of Organization - Candidate Committee
Use this forth to create a new or update an existing candidate committee.
This form must be accompanied by forms CRO -3100 and CRO -3500 (when amending
Amcndmenr
❑ res ❑ Na
only re -submit if anplicable)
1. Committee Information
. Full Name
c. ID Number
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5 P'lY'Z 1
b. Mailing Address (include City, State and Zip Code)
d. Date Organized
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e. Phone Number
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. Candidate Information []Candidate's Primary Committee
. Full Name
c. Candidate m Number
f. Party Affiliation
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(Indicate Non-partisan if applicable
b. Mailing Address (include City, State, and Zip Code)
g. Office Sought
16 5 Se04i0t04 Dd-
LJAAIt A W U- C- 2917
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. Phone Number
d. Email Address
h. Neu Election Year
i. Jurisdiction
16y -614-7K61
lelu.' nn: e e ple(.
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❑ Email copy of notices
. Treasurer Information
4. Custodian of Books Information
. Full Name
a. Full Name
AudrG-ir LAuelle
. Mailing Address (include City, State, and Zip Code)
Joao meso ti I- et.
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b. Mailing Address (include City, State,
JUL 18 2019
Phone Number
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Id. Email Address
lav- 11CeyMA:l.00
c. Phone Number
d. Email Addr
1 prefer to receive notices bj email Yes No
Email copv of notices
5. Assistant Treasurer Information
Add
6. Account Information (incl. CR0-33oo) Add
a. Financial Institution Full Name ILI Remove
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. Full Name JU Remove
b. Mailing .Address (include City, State, and Zip Code)
b. Purpose
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. Phone Number
d. Email Address
c. Account Code
d. Type
Email copy of notices
CERTIFICATION
I certify that the Committee or Fwd is in compliance with all applicable provisions of Article 22A, 22B & 22D -22M 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, We and correct.
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Printed Name of Signer amre of Appointed Treasurer Date
CRO -2100A NC State Board of Elections July 2011
NORTH 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.
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Committee Name:�1�RtMte J�- (s/tJ CAmPAiStJ
Treasurer Name: Audi e v � A 4c ((�-
Treasurer Address: 1000 Mek )J4 C} —A A0.0 V. C. X 8113
(include city, state, & zip)
18 20
Treasurer Phone: %0 `d - 7a S- 6q 6 S
Che One:
1 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. 163-278.10A. 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. 1 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 further agree to file all future reports required.
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Date SignedMg—nature
CRO -3600 Certification of Threshold
NORTH CAROLINA
STATE BOARD OF ELECTIONS
Certification of Treasurer
This Certification is used by Candidate Committees to appoint a treasurer for the committee. This form is
required and must accompany the Candidate's Statement of Organization.
This Certification is filed at the Board of Elections office where the committee's campaign reports
are filed.
FILED BY:
Candidate Name: J Awe: C- )A. �cl U
Treasurer Name:
Treasurer Address: loco Me!"V4 C+ - QA * A W, 0. C. 2817 3
(include city, state, & zip)
[EDbC4D
Treasurer Phone: WA — '10 S
Union Co. Elections
I certify that the above information is correct, and 1, as candidate, appoint said treasure t'T�E}46}PdRg7Rnfll.
the duties and responsibilities imposed upon the appointed treasurer and subject to the penalties and
sanctions in Subchapter 1711. Regulation of Election Campaigns of Chapter 163 of the North Carolina
General Statutes.
I understand that if the above Treasurer changes, it will be necessary to certify a new treasurer and amend
the existing Statement of Organization within 10 days of the vacancy. I further understand that the above
Treasurer is required to receive training by the State Board of Elections within three months of this
appointment according to Article 163.278.9(k).
Date Signed gnature of Candidate
CRO -3100 Certification of Treasurc-
PTE NORTH CAROLINA
STATE BOARD OF ELECTIONS
Confidential _
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:
Treasurer Name:
Treasurer Address:
"51wM'1t te;r.I CAnCAl4t,/
(include city, state, & zip)
Treasurer Phone: ' 4 y -70 S' - 614 0 S
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 (anv 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.
Tvoe of account Financial Institution Address
Account Number Account Code
C1`cak .,
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By signing ththqis statement, I authorize agents of the State Board of Electiot to ' tspect all accounts provided.
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Date Signed of Candidate or Treasurer
For Candidate Committees Only
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!� 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, IeRtjterj�eV; o VIte Board of Elections to, ns ct applicable accounts.
Date Signed JUL 26 2019 S.4aWre of Candidate or Treasurer
Union Co. Board of Elections
CRO -3500 Certification of Financial Account Information