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Wilfong, Gary_2015-CommitteeStatement 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 amendine Amendment ❑ ves )zNn onl re -submit ifaoolicablel 1. Committee Information . Full Name z Lae-�l G A9,L6 QvP-ZL c. ID Number <gli�/n S I F . Nh, iang Addrns (include City, le mind Zip Code) d Dab organized —I- A,,—W r AA, 1 ae Ki I �. /L� � O G ? � e. Phone Number _ --- °`C7S��,Po 2. Candidate Information Candidate's Primary Committee a. FullName 1 /n V W I F e. Candidate ID Number L Parly Affiliation (Indicate Non-partisan ifappbcable) . Mailing Addr s (include City, State, and Zip Code) g. 018ce Sought V50 14 LA t -j L;0 CID 1 {lis N . Phone Number I d. Email Addrear i Nest Election Year L Jurisdiction v a , ,(n ❑Email copy of notice 3. Treasurer Information 4. Custodian of Bothe Information Fail//Name / �� / /^ / r'1' % r IN ( t (—d e j C.J a. Full Name b. Mailiq Address (iaclude City, State, mud Zip Code) b. Mailing Address (include City, State, and Zip Code) I'�� `t L��•-�jez� � cl/ �i104 r ri. �fifi t l Al C-`�� c. Phone Number d. Email Address e, Phone Number Id. Email Address Dy ?3 litzd°oU 1 0 t. r /urn 6 6 or,a,Gr, 4 ,IFS --1 I prefer to receive nintices by email El Yes L3 No L3 Email copy of notices 5. Assistant Treasurer Information Lj Add . Full Name ❑ Remove 6. Account Information (lnd. CRO -3500) Add a. Financial Institution Full Name ❑ Remove b. Mailing Addrem (include City, State, mad Zip Code) It. Purpose . Phone Number tL Email Addreu e. 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 & 2213-22M 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 co It G f. W I I/ WAJ 6 Rutted Name of Signer Signature of Applomil6d Tr mer Date CRO -2700A NC State Board of Elections July 2011 Kim Westbrook Strach Executive Director North Carolina State Board of Elections 441 N Harrington Street Raleigh, NC 27603 Certification of Threshold Mailing Address PO Box 27255 Raleigh, NC 27611-7255 (919) 733-7173 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: Treasurer Name: Treasurer Address: (include city, state, & zip) (o l -MK,.aV/.t,.. %G'*r/ t /V C- 10-LYV7j Treasurer Phone: Check : 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 $1,000 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. ?(,6 0 &! l— Date Signed CRO -3600 Certification of Threshold July 2014 Kim Westbrook Strach Executive Director North Carolina State Board of Elections 441 N Harrington Street Raleigh, NC 27603 Certification of Treasurer Mailing Address PO Boa 27255 Raleigh, NC 27611-7255 (919) 733-7173 This Certification is used by Candidate Committees to appoint a treasurer for the committee. This form is required and must accompany the Candidate's Statement of Organization. This Certification is filed at the Board of Elections office where the committee's campaign reports are filed. FILED BY: Candidate Name: Treasurer Name: Treasurer Address: (include city, state, & zip) uf4Rt-4. (tJ% (7zi�uG � aur. k1 . `2 otcl t--. 120 V-� z✓, r e— !2/l -t (. Kf e: - Treasurer Treasurer Phone: ' ? 0 1 -7 J'S Cr A90 0 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 VHL 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 ascend 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 Flections within three months of this appointment according to Article 163.278.9(k). Dale Signed CRO -3100 Certification of Treasurer u, Signature of Can' ate ✓uh 2014 North Carolina State Board of Flections 441 N Haraugton Sleet Raleigh, NC 27603 Kim Westbrook Strach Executive Director Mailing Address PO Box 27255 Raleigh, NC 27611-7255 (919) 733-7173 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: l'C9 zz-Cor i 0i /P ay C� ��rrz �iAi�t c., FcsJ [icor e <</ Treasurer Name: Ga" i / Fo& 5 Treasurer Address: �V 51 .A a.0 Lc> .t r�1Cr,4,, fnAJ ,— DJ6 ?S (include city, state, & zip) Treasurer Phone: qc) Y i f 3 4,Poe) 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 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. Tvoe of account Fluaneial Institatlon Address Amount Numher Arennnt Cndn sclltt�! 6 X56 '� rlv L�Ale-a1 pl By signing this statement, I authorize agents of the State Board of Elections to inspect all accounts provided. — 21 a0Dam Signed -vTSignature of Candi to orFreasurcr 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 age Vt�ct rVEDections to inspect applicable accounts. Dam Signed JILL 0 8 2095 Signature of Candidate or Treasurer CRO -3500 Certification of Financial Account Information July 2014 Union Co. Board of Elections rJ. P North Carolina State Board of Elections 441 N Harrington Street Raleigh, NC 27603 Kim Westbrook Strach Executive Director Mailing Address PO Box 27255 Raleigh, NC 27611-7255 (919) 733-7173 Candidate Designation of Committee Funds I 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 tiled at the Board of Elections office where the committee's campaign reports are flied. Candidate Name: Committee Name: Treasurer Name: 0 If Candidate is own treasurer, designate an agent to carry out designations: I� i.U/ (fvtild Committee ID #: 8 ll VVI SS. F - Level Registered: [State] [County] If county, specify:I/ tel. ��.1i4[ 2 V etj I, C--%4 J?Aj 11. W i I;q r J & hereby direct that in the event of my death or incapacity all tPBme or 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 (Select from ¢763.278.16B(4)) 1. A�.t�►t� �� � f3� 2. 3. Plan for Disbursement (eg. Amount or %) 10 <3 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: Ad./ / !4 • ` j Zn' aLe Date: 2(& U l c '— RECEIVED CRO -39M Candidate Designation of Committee Fonds ,] �tr' 90842015 Union Co. Board of Elections