Pierce,Rodney_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.
I. Committee Information
a. Same of Committee
d. ID Number
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b. Maibng .Address (include CitJ, State and Zip Code)
e. Date Organized
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c. Committee Website (Optional)
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2. Candidate Information
a. Full Name
e. Part, V'Dliation
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b. )tailing Ad ess (include City, State, and Zip Code)
f. Office So gbt
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c . Phone Number
d. Email Address
g. Next Election Year
It. Jurisdiction
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3. Treasurer Information
4. Assistant Treasurer Information
a. Full Name
a. Full Name
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b. Mailing Address (include City, State. and Zip Code)
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b. Mailing Address (include City, State and Zip Code)
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c. Phone Number
d. Email Address
c. Phone Number
d. Email Address
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5. Custodian of Books Information (Keeper of Records
6. Account Information (in, . CRod500)
a. Full Name
a. Financial Institution Full Name
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b. M211ing.Addreltshisiclude City. State, and Zip Code)
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. Phone Number
it. Email Address
b. Account Code
e. Type
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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.
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Primed Name of Treasurer SignatVe of Appointed Treasurer Date
I certify that the information above is correct, and 1, as the candidate,
appoint said treasurer to personally fulfill the
uties and responsibilities imposed upon the appointed treasurer and subject to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
,ted Name of Candidate
Signature of Candidate Date
CRO -2100A NC State Board of Elections November's i 1,
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.I6B(a).
This Designation is filed at the Board of Elections office where the committee's campaign reports are tiled.
Candidate Name:
Committee Name:
M3
Treasurer Name: J ik'Nwal- ").. • E to 6A%A i5 t
If Candidate is own treasurer, designate an agent to carry out designations: /ti/A
Committee ID #: UE V`n P 3$
Level Registered: [State] [County] If county,
1, t' oikn!" L„tc, hereby direct that in the event of my death or incapacity all
(N' is 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
GSe//(l1eet from§163-278.16B(a))
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3.
Plan for Disbursement (eg, Amount or %)
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By signing this form, 1 certify that the foregoing entities are eligible beneficiaries under N.C.
Gen. Statute 163-278.16B(a). A copy of this form should be maintained with the Committee
records.
Signature of Candidate:
Date: /.L//7
CRO -3900 Candidate Designation of Committee Funds