Mills,Parker_2021-Stmt-of-Org-AmendStatement 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 nen' election Year.
I. Committee Information
a. Name of Committee
e e leek 0(f --X-
it. ID Number
PM
7 o 2- I
b. Mailing Address (include City, State and Zip Code)
e. Date Organized
11
c. Committee Website (Optional)
L Phone Number
�i-t 1�5
2. Candidate Information
a. Full Name
rKer M�1\s
e. Par 1r Aflilialion
1ZepvbllCoh
It. Mailing Address (include City, State, and Zip Code)
L Office Sought
—
CYIGYIYOe hiC (991\1
ii1�11 OYA MC CommISS Dh
c. Phone Number
d. Email Address
g. Next Election Year
h. Jurisdiction
1 CD
<iQ
❑ FinaiI ,opv of re ort notices
3)Treasurer Information
d. Assistant Treasurer Information
a. Pull Name
a. Fnll Name
It. Mailing Address (include City, State, and Zip Code)
It. Mailing Address (Include City, State and Zip Code)
5t 3q F-je e Creekt� ehctrloilt
c. Phone Numberd.
Email Address
a Phone Number
d. Email Address
3019&,37a�s
Send report notices by email Yes 0 No
ITErrail co n of re poi1 notices
5. Custodian of Books Information (Keeper of Records
6. Account Information ..(roar. CRO -3500)
a. Full Name
o (A r-,�-
a. Financial Institution Full Name
b_ . Mailing Address (include City, State, and Zip Code)
CNrnP�iUN Fir;
Charlo NC a-$2�
. Phone Number
d. Email Address
It. Account Code
e. Type
101 Qb8 IYl 5
E3Email copy of report notices
I
I RECEIVE
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�yiil hibited or other non -disclosed funds. I further certify that
this re ort is complete true and correct.
Printed Name of Treasurer Signatme WAppointed Treasurer Date
I certify that the information above is correct, and I, as the candidate, appoint said treasurer to personally fulfill the
duties and responsibilities imposed upon the appointed ZlfiZect penalties in Article 22A of Chapter
163 of the NC General Statutes.
APlwf �4/S �
Primed Name of Candidate Sisiniture of Candidate Date
CRO -2100A NC State Board of Elections November 2019
I
NORTH CAROLINA
State Board of Flections & Ethics Enforcement
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 at the Board of Elections office where the committee's campaign reports are filed.
Candidate Name: 'Pat ker
Committee Name: C.Om rwkkl--e An TJq rk-P r M k
Treasurer Name:jLT��I
If Candidate is own treasurer, designate an agent to carry out designations:
Committee ID #:
Level Registered: [State]ounty If county, specify: 0/i/ 61'2
I, Dirk -ft M/, 5 hereby direct that in the event of my death or incapacity all
(Name of Candidate)
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
(Selea from §163-278.16B(a))
1.
2.
3.
Plan for Disbursement (eg. Amount or %)
ILM /.
By signing this form, I certify that the foregoing entities are eligible beneficiaries under N.C.
Gen. Statute 163-278.16B(a). A copros7 should be maintained with the Committee
records.
Signature of Candidate:
Date: �`� �2 al
UNION COUNTY
CAMPAIGN FINANCE
DEC 0 2 2021
CRO -3900 Candidate Designation of Committee Funds RECEIVED