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Home My WebLink AboutKraybill Organizational Information Amendment Statement of Organization - Candidate Committee ❑ Yes ❑ No 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. [.Mailing mmittee Information Name c.ID Number Address(include City,State and Zip Code) d.Date Organized fuse- ems i RECEIVED 2- z1 Id f"� `- ;:;y e.Phone Number L FEB a f� F Information Candtdate's Primary Committee c.Candidate ID Number d.Party Affiliation ss(include City,State,and Zip Code) e.Office Sought f.Jurisdiction 0 KG (If office sought is nonpartisan, write "Nonpartisan"in[dJ Party Affiliation.) 3.Treasurer Information 4. Custodian of Books Information a.Full Name a.Full Name O J A- - Mailing Address(include City,State,and Zip Code) b.Mailing Address(include City,State,and Zip Code) af� 0,0_a�e_p, L«042, NI k Oamm , OlC, 00405 c.Phone Number d.Email Address c.Phone Number d.Email Address FFull Ltstant Treasurer Informati d 6.Account Information (inc1. cao-3soo) Add ame ❑ Remove a.Financial Institution Full Name ❑ Remove Mailing Address(include City,State,and Zip Code) b.Purpose carn_P&`T accourt- c.Phone Number d.Email Address c.Account Code d.Type C-hCe.�l. c�cCvc� 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 correct. ` zrz 1(� Printed Name of Signer S n ture of Appointed Treas re Date CRO-2100A NC State Board of Elections December 2007 }t DECEIVED ` FEB 12 ;'" ' North Carolina State Board of Elections NHC Bd 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: t/ Candidate Name:Treasurer Name:Name: 5 L PR rI[� Treasurer Address: t" �� U OO E� (include city, state,&zip) L0 L LAI A)6iW o ) 06- Z"o j Treasurer Phone: 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 163.278.9(k). -711 1A ID Date SIgned \ Signature of Candidate Note:This Certification is to be filed at the Election Board where the committee's campaign reports are filed. CRO-3100 Certification of Treasurer Jame 2007 DECEIVED North)*Carolina FEB 12 2010 State Board of Elections NHC Bd 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 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 nine allowable methods outlined in 163-278.16B(a). Candidate Name: (,_ K VA-` &-I LL. Committee Name: COAA YI 1 TTFr -V UU-&-r-5�k AT-�(E t<" ` 1 12�t LL- Treasurer Name: ST P4A-r6(: L- VA�AgB1U, If Candidate is own treasurer, designate an agent to carry out designations:wA-1;7-PT• "&LIL Committee ID #: Level Registered: [State] comf)If county, specify: tom(%UO kftl`)000 — I, STt�PUAYk)IG L- KQ-MBthereby 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(e:;. Amount or%) (Select from§163-278.16B(a)) 1.1 K4-o6oea,6v Gtalccl ?M5 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: C� Date: ( Z� �o Note:This Designation is to be filed with the Election Board where the committee's campaign reports are filed. CRO-3900 Candidate Designation of Committee Funds December 2009