Bickel Organizational Forms (UT) 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 foams CRO-3100 and CRO-3500(when amending,oii1v te-submit it applicable).
I.Committee Information
it.Full Name c.ID Number
............................. ... ........................
b.Mailing Address(include City.State and Zip Code) d.Date Or 11 ga.n I ized
.................
C�-k -7/5115
—2�'V 403 JUL 15 2013 0.Phone Number.
A 7-
L Candidate Information ❑C'andidate's Primate colurnittee
a.Full Name c.c aadida1,11)Number L part} AffillAwl,
{Indicate Nota-p if applicable)
b.Mailing Address(include City,State,and Zip Code) g.Office Sought ......
——------------ ----------
"C'41s
'50 i 0 (jr
c.Phone Number d.Email Addreits It.Next Election Year Jurisdiction
,(, 7st� 3 d.... cLc;Wc. rr,cot ZU�3 N" L M
inail copy of notices -1
3.Treasurer Information 4.Custodian of Books Information
a.Fail,Name a,Full.Name ----------
b.Mailing Address(include City.State.and Zip Code) b.Mailing Address(include C,it7%-,State,,and--Zip,Code)
..............
Phone Number d.Email Address c.Phone Number d.Ejuafl Address
1 1P17 44 am
I prefer to receive notices by email es; [I No El Email cop
1, _y of notices Add
5.Assistant Treasurer Information Adid 6.Account Information wicl CRO-3jOO)
a.Fuu.Name ❑U Remove a.Financial Institution Full Name ❑ Remove
..............................................
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b.'Mailing Address(include City,State,and Zip Code) b.Purpose
c.Phone Number d.Email Address c.Account Code d.Type
----------------------------.......-------------.....
13 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 gled with prohibited or other non-disclosed funds.
.Idscare cot
I further certify that this report is complete.true t.
Dgavez--JIJ
fAd- f
Printed Name of Signet S a f Appointed Treasurer DI;
CRO-2100A NC State Board of Elections May 2011
M RECEIV
North Carolina JUL 15 2013
State Board of Elections
441 N Harrington Sheet NHC Bd
Raleigh,NC 27603 Of Electrons
Kim Westbrook Strach 11ailing Address
Executive Director 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 163-278.16B(a).
Candidate Name: �16 �;o�� [� /
Committee Name: "Ck -►,ff (O i
Treasurer Name: e.I
If Candidate is own treasurer,designate an agent to carry out designations: '44,
Committee ID#:
l
Level Registered: [State] oun ]If county,specify: 61) 1 o-V\0�'e.V
&L k�e I ,hereby direct that in the event of my death or incapacity all
(None 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 flan for Disbursement(c% Amount or%)
(.Wed frum§)63.27&16B(a))
3-
By signing this form,I certify that the fo egoing entities are eligible beneficiaries under N.C.
Gen. Statute 163-278.16B(a). A copy o this for ould be maintained with the Committee
records.
Signature of Candidate:
Date: 12 3
Note:This Designation is to be flied with the Election board where the committee's campaign reports are filed.
CRO-3900 Candidate Designation of Committee Funds May 2013
North Carolina JUL 15 2013
State Board of Elections
441 N Harrington Street NHCi Llfs c
Raleigh,NC 27603
Kinl Westbrook Strach Mailing Address
Exccutive Director 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:
Treasurer Name:
Treasurer Address: �Z 01 o-vA�rvic, ,
(include city,state,&zip) ` t 1�tvlLiTiln
Treasurer Phone: 91 U"3 0-5113
1 certify that the above information is correct,and 1,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 V111.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 th nths of this
appointment according to Article 163.278.9(k).
-711 G I/
Date Signed Signature of Candidate
Note:This Certification is to be tiled at the Election Board where the committee's campaign reports are filed.
CRO-3100 Certification of Treasurer May 2013
y
, ,r t ?k ;
K
North Carolina
State Board of Elections
441 N Herrington Street
Raleigh,NC 27603
K.itn Westbrook Strach TMailing Address
Executive Director PO Box 27255
JUL 15 2013 Raleigh,INC 27611-7255
(919)733-7173
NHC Bd of Elections Pax (919)715-8047
Certification of Threshold
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.
FILED BY: > f
Committee Name: Delye�.���.��1 d� t)-h1G; I
Treasurer Natne: i �� �dlel
Treasurer Address: i3U1 Hdk4.+L he
(include city,state,&zip) 1�
Treasurer Phone:
�k one:
1 certify riify 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 MALL AT THE BEGINNING ON 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 tier all contributions atesigfnature een previously
reported from the beginning of the current election cycle.I orts required.
71/1-2117 Daft Signed
Note:This Certification is to be tiled at the Elec tion board where the committee's campaign reports are tiled.
CRO-3600 Certification of Threshold May 2013