Merrell, Melissa_2021-CommitteeStatement of Organization - Candidate Committee Is this statement:
New ❑ 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
. Name of Committee
d. ID Number
Kassa. Merrell �or r••N.iss; f,vr
53•M'ly\1
b. Mailing Address (include City, State and Zip Code)
e. Date Organized
2(003 6AKW-os I in
C ?A104
h 12-0 Z_
c. Committee Website (Optional)
I. Phone Number
Merrell--or$DCC. Cow,
704-$43-2742-
2. Candidate Information
a. Full Name
a Party Affiliation
Me .SSG. ann i n rr t t
12w f L Jot
b. Mailing Address (include City, State, an Zip Code)
1. Office Sought
Cou^ Covv w;ss.tof'er
2-4o 03 AAb6 Ar ec s (►ate
��� C 2-et04
. Phone Number d. Email Address
g. Next Election Year
IhAurisudiction
2 0 ZZ—
704-8Q1.2742_ a rnm err el(S aot • Conn
I uni aur eou„{y NC
® Email copy of report notices
3. Treasurer Information
4. Assistant Treasurer Information
a. Full Name
a. Full Name
,n
Me�is5a NA nninr, Meef`e-tl
b. Mailing Address (include City, State, and Zip Code)
It. Mailing Address (include City, State and Zip Code)
2(003 Q Ibt Dss LrN -
SJ•wLl:i, s iiSC gT"k
I, ---
c.
c. Phone Number
Iti. Email Address
c. Phone Number
d. Email Address
76'1•$43.2742.
YViMMtr'rtlt�ppl • Ca..n
Send report notices by email CR Yes ❑ No
U Email copy of report notices
5. Custodian of Books Information (Keeper of Records
6. Account Information (met CRO -3500)
a. Full Name
a. Financial Institution Full Name
Me 1550 MGnn tf� Me, t-etl
�rui 5A' OUNTY
b. Mailing Address (include City, State, and Zip Code)
2-c0o3 ,4\b44`10 s (,s..
S 1r^tl; s N C- Zg 104
3!k6FlNlANUI
OEC 16 2021
c. Phone Number
6N•443.271L
d. Email Address
M M crG
b. Account Code
2513
c. Type IVE
Bu9t"4s oea
I
ag 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.
6
IAEV'0 6-
Printed
Printed Name of urergnature
of AfMinted Treasurer Dale
1 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.
IMZhtssa M• Grr
Printed Name of Candidate
2 / lOx
S aturc fatdilate ate
GKO-2160A NC State Board of Elections November 2019