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Teague,Charles_2022-!-Stmt-of-Org
Statement of Organization - Candidate CommitteeIs New 0 Amended his statement: Use this form to create a new or update an existing candidate committee. This form must be accompanied by form CRO -3500. An amended tbrni is required for each new election year. 1. Committee Information . Name of Committee / d. I I) N umber (hlh) ''+"t +o L Ir(� C 1��Ck � 2Q�� FL)r (_le `iL b. Mailing Address include City, State and Zip Code e. Date Organind 112800 -me -rot) ourt onroe Afe ANZ 2 4-22 . Committee Website (Optional) E Phone Number 2. Candidate Information . Full Name e. Party Affiliation _ Charles uck Tea u� Re li an CANTAONFN, In. Mailing Address (include City, State, and Zip ode), f, Office Sought Clerk of Clourt 928 8(merel) 00uft Mon(De C x8112 e. Phone Number d. Emil Address g. Next Election Year b. Jurisdiction 404-;21.0939 erCdgua 19JD29ymail.@om 7 Union ❑ Email copy of report notices 3. Treasurer Information 4. Assistant Treasurer Information a. Full Name a. Full Name ACbra. Ae'(,or1(1r- - -- -- Tule OVJ��S (IAICIf b, Mailing Address (include City, State, and Zip Code) b. Mailing Address (include City, State and Zip Code) 31 Z8 Country Villa Dr. Mon rot. NC )8110 29Qet Santiago Cty - Monroe NL c. Phone Number Id. Email Address c Phone Number jo+(021-iOW5 d. Email Address dmecorkle 2o5elmaf l ,10405 4- -u liedBri'.hVIP.1 (@fne, ebm Send report notices by email Yes ONo L1 F.mail co )% of re port notices 5. Custodian of Books Information (Keeper of Records 6. Account Information (incl. CRO -35m) n. Full Name sulie, O, `f Ink e a. Financial Institution Full Name FIrSr ITl sIn. Mailing Address (include City, State, and Zip ode) 312-9 6ountry Villa 6r monrUe 1J- 019/10 e. Phone Number Id. Email Address b. Account Code ,d� a Type Cheelcinrj Au --t JP6 f d oln In i ffe C. 7o4.5o,7- 19 Julie [3Email copy of report notices I certify that the Committee is in compliance with all applicable provisions of Article 22A of Chapter 163 of the INC 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. Tulp ewens BrIWey 3"t -'26.2a Printed Name of Treasurer I Signature of Appointed Treasurer Date I certify that the information above is correct, and 1, 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 ofthe -NC General Statutes. )_ JACk %f6o,-, ( 3 Printed Name of Candidate Signature of Candidate Date CRO -1100A NC State oard of Elections November 2019 VOTE © NORTH CAROLINA STATE BOARD OF ELECTIONS _r�ioN cou�. AMPAIGN FIN Candidate of Committee Funds MAR 02 201, 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 163-278.16B(a). This Designation is riled at the Board of Elections office where the committee's campaign reports are filed. Candidate Name: Committee Name: Treasurer Name: C-� nl( 6e If Candidate is own treasurer, designate an agent to carry out designations: Committee ID #: -C),7M q' E Le—vel Registered: [State] [County] If county, specify: (1\ u rN I, JACk L ha ✓ los Tea Cyc, v, hereby direct that in the event of my death or incapacity all (Name 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) he paid in the following manner as permitted by N.C. Gen. Stat. 163-278.16B(a). Name of Entity (Select from §163-2 M 1611(a)) 1._ Cat1v'afRptisz ChVrfh 2. NtOAroepG 3. Plan for Disbursement (eg. Amount or %) )ye) By signing this form, I 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: ✓ t Date: 3 Z ZZ CRO -3900 Candidate Designation of Committee Funds