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Stmt of Org_Joe PollinoStatement of Organization - Candidate Committee l AmenY, C E Use this form to create a new or update an existing candidate committee. This form must be accompanied by forms CRO -3100 and CRO -3500 (when amending, only re -submit if applicable). No l ComlgitteeInfarmption e. Full Name c. ID Number Committee to Re -Elect Joe Pollino 2JM5KE d. Dale Organized b. Mailing Address (includ. City, State ead Zip Code) 7/25/17 1253 Firethorne Club Dr, Waxhaw, NC 28173 e. Phone Number (704) 292-5301 2, Candidate Informatiioa 'Candidate's Yr)mary Cammittea v. Full Name e. Caudidate to Number LPartyAmliaaon Joseph Ennily Pollmo 2JM5KE (Indicate Non-partican if applicable) b. M.illug Address(helude City, Sldu mal Zip Cade) g. Office Sought 1253 Firethome Club Dr, Waxhaw, NC 28173 Mayor c. Phone Number '1 d.Em.it Address h. Neat Election Year i. Judsdiction (704) 292-5301 jpollinojr@gmail.com Marvin _ Email copy of notices 3. Treasurer Information4, Cmstodlap of Books Information a. Full Nem. ..Full Name Audrey Lavelle b. Meiling Add. (iaelude Cit, State, uad Zip Code) b. Mailing Add.. (include City, Slate, sad Zip Code) 1000 Madinah CL, Marvin, NC 28173 c. Ph one Number d.Emvil Address c.Ph... Number d.Emell Address (704) 705-0405 audreylavelle@gmail.com I prefer to receive notices by email Yes No ©— Email copy of notices S. Assistant Tmasurerilnform ttion, '. Add nmana�� 6: e&ecaunt7nforjpatboa (lnet. CRo-3,fkoj "Add ' a. Full Name Remove a. Fi... chd lmtitulion Full Name Remove b. Moiling Address (iocludo Ci), Slate, and Zip Code) b. Purpose c.Phone Number d.Emaii Address c. Account Code d, Type - `" Email copy of notices `. CERTIFICATION I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 22D -22M of Chapter 163 of the NC General Statutes agedoiall no funds are commingled with prohibited or other non -disclosed funds. I further certify that this report is complete, hue and cortect. Rimed Nameof Signer Sigr& of Appointed Treasurer Date NC State Board of Elections May 2011 RECEIVED JUL 2 7 2017 Union Co. Board of Elections Y{ �VL'9 9� V' North Carolina State Board of Elections 441 N Harrington Street Raleigh, NC 27603 Kim Westbrook Strach Executive Director RECEIVED JUL 272017 Union Co. Board of Elections Mailing Address PO Box 27255 Raleigh, NC 27611-7255 (919) 733-7173 Certification of Threshold This 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: C orRtm i i -+e e -6 _Rt - EI ec}- atm -Po I I : +, o Treasurer Name: Y�Vdrey Live\�� Treasurer Address: I ori med � nati, CA. (include city, state, & zip) molls- V t,(1 (uC >7 8 113 Treasurer Phone: Jot{— 171b'9- Check es Check One: I certify that this committee intends to neither receive nor expend more than $1,000 during the current election 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 $1,000fifeshqld. I will now be required to file the next scheduled report for all contributions and expend' est av ee eviousl� reported from the beginning of the current election cycle. I further to all t ere require . -1Ia�GllI Date Signed CRO -3600 Certification of Threshold July 2014 Kim Westbrook Strach Executive Director ti North Carolina State Board of Elections 441 N Harrington Street Raleigh, NC 27603 Certification of Treasurer RECEIVED JUL 2 7 2017 Union Co. Board of Elections Mailing Address PO Box 27255 Raleigh, NC 27611-7255 (919) 733-7173 This Certification is used by Candidate Committees to appoint a treasurer to the committee. This form is required and must accompany the Candidate's Statement of Organization FILED BY: Candidate Name: Treasurer Name: Treasurer Address: /000 (include city, state, & zip) Treasurer Phone: vel 6 nal-, CA-. YYlctc^orin. roc a9-173 -7©y - i U,5,-0�1eS I certify that the above information is correct, and I, as candidate, appoint said treasurer to personally fulfill the duties and responsibilities imposed upon the appointed treasurer and subject to the penalties and sanctions in Subchapter VIII. Regulation of Election Campaigns of Chapter 163 of the North Carolina General Statutes. I understand that if the above Treasurer changes, it will be necessary to certify a new treasurer and amend the existing Statement of Organization within 10 days of the vacancy. I further understand that the above Treasurer is required to receive training by the State Boan appointment according to Article 163.278.9(k). Dale Signed Note: This Certification is to be riled at the Election Board where the committee's campaign reports are tiled. CRO -3100 Certification of Treasurer July 2014 :gifrtv � a`�lf � l�n�SCyv NorthCarolina State Board of Elections 441 N Harington Street Raleigh, NC 27603 RECEIVED JUL 2 7 2017 Union Co. Board of Elections Kim Westbrook Strach Mailing Address Executive Director PO Box 27255 Raleigh, NC 27611-7255 (919) 733-7173 Con cdential 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: C,cn vw, % kkf io "Re. - Cl ec-k -�s rZe -Po cm Treasurer Name: iq M v e L xv e-tte- Treasurer Address: i 00,ZD MEd; nam C+ (include city, state, & zip) C v i .n o c Treasurer Phone: ] _ -1-4s -clyoS I certify that the information provided below is true and accurate. I am providing all account information for the above named Comrnittee. 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 signing this statement, I authorize agents of the State Board of Elections to inspect all accounts provided. Date Signed Signat lS f Candidate or Treasurer For Candidate Committees Only 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 warrant 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 CRO -3500 Signature of Candidate or Treasurer Certification of Financial Account Information July 2014 D 2 0 ID CI to