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Palandri,Gina_2021-CommitteeStatement of Organization - Candidate Committee Iv* this statement: 9] �v 13 Amended Use this form to create a new or update an existing candidate committee. This form must be accompanied by form CRO _9500. An amended form is required for each new election year. 1. Committee Information a. Name of Committee r S LL;" s d. ID Number 9 7t-4 1 R7` b. Mailin Address (include City, State and Zip Cod . ell e. Date Organized (n23 Pe .44r,- Dai- LAnle ?/70/242/ a Committee Website (Optional) 6vi1,1v✓ 61 j'/"" !Siwll., (nw E Phone Number 6)ad��s35� . Candidate Ififtfirmation a. Full Name e. Party Affiliation Z)e 'W yr C I -A -AC _ _ �9 cl Na . 1 %f L/i!v !%le b. Mailing Address (include City, State, and Zip Code) f. Office Sought 1023 F{Atitir 0 4L I -em f C p(,p h Cr . Phone Number d. Email Address g. Next Election Year h. Jurisdiction bi�xy657,G MP�.� s; /rGrzti I un)zipw ❑ Email co of report notices 3. Treasurer Information 4. Assistant Treasurer Information a. Full Name a. Full Name 6/n/A M P44-AN0041 It. Mailing Address (include City, State, and Zip Code) It. Mailing Address (include City, State and Zip Code) 102-3 t e,-4At r 04-t Lp,v C c. Phone Number d. Email Address c. Phone Number Id. Email Address biz 3115356 jmQ,-i.k6/-r ye ftvtgr7,CcAl Send report notices by email Myes No Email Copy of re ort notices 5. Custodian of Books Information (Keeper of Records 6. Account Information (incl CRO -3500) a. full Name a. Financial Institution Full Name h. slailine Address (include City, State, and Zip Code) P. �P c. Phone Number d. Email Address b. Account Code c "I pr C41t Gni s mail 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. 61fl/AV14, PALIIIVP14 '22ov .X7 S/Z/ Printed Name of Treasurer Signature of Appointed 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 treasurer and subject to the penalties in Article 22A of Chapter 163 of the NC General Statutes. 6 I AIA W, GfcAIVaZ7' hz, Printed Name of Candidate Signature of Candidate Date CRO -2100A NC State Board of Elections November 2019 NORTH CAROLINA STATE BOARD OF ELECTIONS Certification of Threshold "phis 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. FILED BY: Committee Name: /NA �7j/ J'f/tLCA-� Treasurer Name: G INF}- f,4 L*/,j P/l. I Treasurer Address: /9Z 2) >edei Da,- 1AWe (include city, state, & zip) 6+Ak,L-11 9 S All 2U/0y Treasurer Phone: 53 S(�o 01 tZ AGN Check One:�� �( I certify that this committee intends to neither receive nor expend more than $1,000 during the current electin 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. I 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. anal Date Signed Signature CRO -3600 CRO -3600 Certification of Threshold VOTE © NORTH CAROLINA UM 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) Treasurer Phone: 6-1,q q Ya/L t vk� 5 4'81 A- PALANv21' 1023 Fe444-ei- 04L 64-1e UNIONCOINNTY X16 2021 I certify that the information provided below is true and accurate. I am providing all account infohrh named Committee. These account numbers include all bank accounts utilized, credit card accounts, savings accounts, or any other financial account used for any purpose by the Committee. ==vEI ro or a above money market or 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 designate 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. Type of account Financial Institution Address Account Number Account Code Ghe <I %vr.Gls�lr APs By signing this statement, I authorize agen[sc....., ,.,,,, .., u,op.,.a mr now rovided. Date Signed Signature of Candidate or Treasurer For Candidate Committees Onlv 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 warrent 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 Signed Signature of Candidate or Treasurer CRO -3500 Certification of Financial Account Information