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JPropst-Stmt OrgStatement of Organization - Candidate Committee 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 \mendmem ❑ ) es No only re -submit if aunlicablel 1. Committee Information . Full Name Committee to Elect Janice Propst c. 11) Number SJMR33 b. Mailing Address (include City, State and Zip Code) 531 Weddington Rd, Matthews, NC 28104 d. Date Organized 7/6/2015 e. Phone Number 704 849-6759 2. Candidate Information []Candidate's Primary Committee a. Full Name Janice G Propst e. Candidate ID Number SJMR33 f. Part) .Affiliation (Indicate Non-panican if applicable) b. Mailing Address (include City, State, and Zip Code) 531 Weddington Rd, Matthews, NC 28104 g. Office Sought Council District 4 c. Phoot Number d. Email Address _ h. Nut Election Ymr i. Jurisdiction 704 849-6759 janicepropst@windstream.net Weddington 0 Email copy of notices 3. Treasurer Information 4. Custodian of Books Information a. Full Name a. Full Name Janice G Propst h. )lallio;; Address (include City, State, and Zip Code) 531 Weddington Rd, Matthews, NC 28104 b. Mailing Address (include City, State, and Zip Code) c Phone Number 704 849-6759 Id. Email Address c. Phone Number d. Email :\ddress anicepropst@windstream.net I prefer to receive notices by email Q Yes ❑ No ElEmail co v of notices 5. Assistant Treasurer Information Aad a. Full Name ❑ Remove 6. Account Information (incl. CRO -3500) Lj Add a. Financial Institution Full Name ❑ Remove b. Mailing Address (include City, State, and Zip Code) It. Purpose C'am toga `ne Gins . Phone Number Email Address a Account Code d. Type Id. J6 P10 K �� 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 and that no funds are commingled with prohibited or other non -disclosed funds. I further certify that this report is complete, true and correct. / Printed Name of Signer re of Appointed urer � Date CKf6I1017A NC State Board of Elections May 2011 Kim Westbrook Strach Executive Director North Carolina State Board of Elections 441 N Harrington Street Raleigh, NC 27603 Certification of Treasurer Mailing Address PO Box 27255 Raleigh, NC 27611-7255 (919) 733-7173 Fax: (919) 715-8047 This Certification is used by Candidate Committees to appoint a treasurer to the committee. This forth is required and must accompany the Candidate's Statement of Organization FILED BY: Candidate Name: Janice Propst Treasurer Name: Janice Propst Treasurer Address: 531 Weddington Rd (include city, state, & zip) Matthews, NC 28104 Treasurer Phone: 704 849-6759 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. 1 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 Board of Elections within three months of this appointment according to Article 163.278.9(k). 07/06/2015 9 - Date Signed Signature o ani , e Note: This Certification is to be filed at the Election Board where the committee's campaign reports are filed. CRO -3100 Certification of Treasurer alar 2013 Kim Westbrook Strach Executive Director I ,J North Carolina State Board of Elections "l N Harrington Street Raleigh, NC 27603 Confidential Mailing Address PO Box 27255 Raleigh, NC 27611-7255 (919)733-7173 Fax: (919) 715-8047 I 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: Committee to Elect Janice Propst Treasurer Name: Janice Propst Treasurer Address: 531 Weddington Rd, Matthews, NC 28104 Treasurer Phone: 704 849-6759 I certify that the information provided below is true and accurate. I am providing all account information for the above named Committee. 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 designate 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. �f Date Batu £Candidate rTreasurer 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 519nature of Candidate or Treasurer Certification of Financial Account Information May2013