Loading...
Mills, Parker_2021-Stmt-of-OrgStatement of Organization - Candidate Committees this statement: New Q 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 Commi Itee d. ID Number o ee'0Z '-X- sP KV0al b. Mailin Address (include City, State nd Zip C de) e. at O anized I I c. Committee Website (Optional) E Phone Number 2. Candidate Information a. Full Name e. Party Affiliation L b. N l ailing Address (include PY, State, nd Zip Code) LOffice gought . Phone Nnmber it. Email Address g. Next Election Year .Jurisdiction o�-- ❑ I[mail copy of report notices 3.Treasurer Information 4.AssistantTreasuftfInfoation7 - 'j:. a. Full Name a. Full Name u h. Mailing Address (include City, S t and Zip Code) b. Mailing Address (include City, St d �• ,�- e [dao /z d,f, oP ` ri— RECEIVED c. Ahone Number d. Email Address c. Phone Number d. Email Address � 97�-�y Send report notices by ema' Yes No LI Email copy of report notices 5. Custodian of Books Information (Keeper of Records 6. Account Information. pncL Cao -3500) a. Full Name ✓r a.Financial Imift ution Full)lame r I S Z AIA' b. Mailing Address (inc City, State, and Zip Code) k-w� e C Or -- c. Phone N d. Email Address b. Account Code e. Type D 2 3d to o I&H Email copy of report noti 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 comp te, tr a and correct. �Lr, 7�z Printed Name T urer store of Appointed Treasurer Date I certify that the information above is correct, and I, a candidate, appoint said treasurer to personally fulfill the duties and responsibilities imposed upon the appointed trea r an subject to the penalties in Article 22A of Chapter 163 oft NC neral Statutes. ��% L / 7 zd z - Printed Na ne of Candidate igna re of Candidate ate CRO-2I00A NC State Board of ec[ions November 2019 ,C VOTE © NORTH CAROLINA STATE BOARD OF ELECTIONS 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: (include city, state, & zip) "",li n p AIL Treasurer Phone: /0 q— 90W — 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 (any 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. By signi g this tement, I authorize agents of the State Board of Elections to Date Si ed For Candidate Committees Only accounts provided. Ll In lieu of providing account information, I certify that this committ will not raise any money nor spend any money except that which is the candidate's personal funds. I fntherm a understand that an audit or investigation could wan ant 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 Signature of Candidate or Treasurer CRO -3500 Certification of Financial Account Information VOTE VTrj NORTH CAROLINA STATE BOARD OF ELECTIONS Candidate Designation of Committee Funds This form is used by candidate committees only and allows the candidate to designate in the event of their death, how the committee's funds are to be disbursed using the eight allowable methods outlined in 163-278.16B(a). This Designation is filed atAhe Bolyd of Elections office where the committee's campaign reports are filed. Candidate Name: Committee Name: Treasurer Name: If Candidate is own treasurer, designate an Committee ID #: Level Registered I, to carry out designations: [State] i(Countyj4f county, specify: 1j,00 hereby direct that in the event of my death or incapacity all (Name oMandidate) funds remaining in my Campaign Committee account(s) (after payment of permitted outstanding debts or reasonable expenses for winding up the Committee or closing office) be paid in the following manner as permitted by N.C. Gen. Stat. 163-278.16B(a). Name of Entity (Setectfmm §363-178.36B(a)) 2. 3. Plan for Disbursement (eg. Amount or %) By signing this form, I certify that the foregoing entities are eligible beneficiaries under N.C. Gen. Statute 163-278.16B(a). A copy oft ' or should be maintained with the Committee records. SignaturLe U" Date: CAMPAIGN FINANCE L� JUL 2 0 2021 RECEIVED CRO -3900 Candidate Designation of Committee Funds