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Home My WebLink AboutBright Organizational Information & Certification of Inactive Status F---I A-A, ,Amendment Statement of Organization - Candidate Committee OYes 0No Use this form to create a new or update an existing candidate committee. This form must be accompanied bv forms CRO-3 100 and CRO-3500. Committee Information Full Name c.ID Number �j b.Mailing Address(include City,State and Zip Code) d.Date Organized L4 to 0�ecL V\AO-1— Oil I C, e.Phone Number Lj 714 2.Candidate Information LJ Candidate's Primary Committee a.Full Name c.Candidate ID Number d.Party Affiliation b:Mailing Address(include City,State,and Zip Code) e.Office Sought f.Jurisdiction 11 CYC NC �6LA (If office sought is nonpartisan, write "Nonpartisan"in[d] Party Affiliation.) I'Treasurer Information 4.Custodian of Books Information a.Full Name a.Full Name ��;;-( � s ��c, 1�� RECEIVED b.Mailing Address(include City,State,and Zip Code) b.Mailing Address(include City,State,add,Ztp Cod6) ?010 Ll (A NHC Bd of Elections c.Phone Number d.Email Address c.Phone Number d.Email Address 5.Assistant Treasurer Information L] Add 6.Account Information (in j Ad a.Full Name ❑ Remove a.Financial Institution Full Name ❑ Remo b.Mailing Address(include City,State,and Zip Code) 1).Purpose c.Phone Number d.Email Address c.Account Code d.Type I 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 Printed Name of Signer Signature of Appointed Treasurer Dat� CRO-2100A NC State Board of Elections December 2007 RECEIVED North Carolina FEB 0 8 2010 State Board of Elections NHC 6d of Elections 506 N Harrington Street Raleigh,NC 27603 Kimberly Westbrook-Strach Mailing Address Deputy Director—Campaign Reporting PO Box 27255 Raleigh,NC 27611-7255 (919) 733-7173 Fax: (919) 715-8047 Certification of Treasurer 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: [...O\ i Q n q �' (1 P✓5 cj h� Treasurer Name: �C�\ki r 5 Treasurer Address: L-A O 1 b (include city, state,&zip) Z)QJ— Treasurer Phone: C) — act q 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 Board of Elections within three months of this appointment according to Article 163.2789(k). Date Signed Signature of Candidate Note:This Certification is to he filed at the Election Board where the committee's campaign reports are filed. CRO-3100 Certification of Treasurer June 2007 r � RECEIVED North Carolina FEB 0 8 2010 State Board of Elections NHC Bd , " =sections 506 N Harrington Street Raleigh,NC 27603 Kimberly Westbrook-Strach Mailing Address Deputy Director—Campaign Reporting PO Box 27255 Raleigh,NC 27611-7255 (919) 733-7173 Fax: (919) 715-8047 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 163-278.1613(a). Candidate Name: -\w\1 GaC, c—"CAGc\e,�) Committee Name: 1✓keJc--t L\\\\ukN —k ttR- Treasurer Name: Q, • P\A k\r1` If Candidate is own treasurer, designate an agent to carry out designations: Committee ID#: Level Registered: [State] [County] If county, specify: I, Li 11 k n tJCt`��e5 (S -' ht, 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) be paid in the following manner as permitted by N.C. Gen. Stat. 163-278.16B(a). Name of Entity Plan for Disbursement (eg. Amount or%) (Select from§163-278.16B(a)) 2. 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: - Dat - U� Note:This Designation is to be tiled with the Election Board where the committee's campaign reports are Sled. CRO-3900 Candidate Designation of Committee Funds June 2007 North Carolina State Board of Elections 506 N Harrington Street Raleigh,NC 27603 Kimberly Westbrook-Strach Mailing Address Deputy Director—Campaign Reporting PO Box 27255 Raleigh,NC 27611-7255 (919) 733-7173 Fax: (919) 715-8047 Certification of Inactive Status This certification is used by Candidate,Party,PACs and Referendum Committees to declare their intent to be inactive, which is not raising or spending any money on behalf of the campaign FILED BY: Committee Name: ��' � f`C T j-- t l 1 f� r-) c (- Treasurer Name: o ,J t r cA , Treasurer Address: q p /19 C .v A E, (7v U (include city,state,&zip) Lj L y- 4 U -3 ) Treasurer Phone: i ) U 3 .2- j D D C; I certify that the above named candidate/political committee intends to receive no contributions,nor make any expenditures,until the committee resumes activity. I understand that if the above circumstances change,it will be necessary for the person responsible for filing financial disclosure reports to file an amended Statement of Organization and the Certification to Return to Active Status form(CRO-3300)within ten days. L ate Sign d Signature Note:This Certification is to be riled at the Election Board where the committee's campaign reports are filed. RECEIVED AUG 2 0 2012 IL. r01 '^ "-1 ^f Elections CRO-3200 Certification of Inactive Status June 2007