Palacios,Maria_2021-Stmt-of-OrgStatement 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
a. Name of Committee d. ID Number
Comm��ite -to MaYip. Pcx\�c:o
Mailing Address (include City, State and Zip Code)
e. Date Organized
-ARO-5 c-f0.Yr;50V\ C -3r I k40(XY0e I N C a nit I a "a o a
C. Committee Website (Optionaq
f. Phone Nanib er
DEC 2 R 907 -5519
2. Candidate Information
a. Full Name
Mateo.
e. Pa lm/iti 0. E1eCtion
bemoCYOrtt
b. Mailing Address (include City, State, and Zip Code)
f. office Sought
'S -W6 CA .
Morro NC \l0
�d o � Edv cc�k�or►
�i�iYi C 3
. Phone Number
d. Email Address
g. Next Election Year
1h. Jurisdiction
oy) a6`1 �Slo(
con}octc>J cnal �Ol I uC cc
, a O a a
Y,pau d o4
EA `) rum. «l
Ed Email copy of report notices
3. Treasurer Information
4.:kssistant Treasurer Information
a. Full Name
a. Full Name
(-rV'�+0t1 V-0bw)Son
b. Mailing Address (include City, State, and Tip Code)
b. Mailing Address (include City, State and Zip Code)
3`700 VtCd VbX. iyoa:\
wi:mk y) SOY\ "C a`b 10q
_
. Phone Number
d. Emall Address
C:65-tc.10=
c. Phone Number
Id. Email Address
3vo 979
Send report notices by email ® Yes ONo
Email copy of report notices
5. Custodian of Books Information (Keeper of Records
a. Full Name
IM CU`s. cl Pckkcx( BOJ
6. Account Information rine!. Cxo-3JM)
a. Financial Institution Full Name
F�r�! Ct�;zen Banff
b. Mailing Address (include City, State, and Tip Code)
Y10-3 CactrriSOrl C -)t
tA00TCoti I a-75110
c. Phone Number d. Email Address
{ 7 - ► caM�ctnangN tQf11
b. Account Code
U 01'
c. Type
b���leSS
CSC c Y>
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 oro er non -disclosed funds. I further certify that
this report is complete, true and correct.
19, 4 b A 49 1
Printed Name of Treasurer amrc of Appointed Treasurer I 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 treasurer and subject to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
1"t.AYio- TQ,GiC\�S 1;�-2-2r-aoal
Printed Name of Candidate Signature ottandidatc Date
CRO -2100A NC State Board of Elcctionl November 2019