CRO-3900 Candidate Designation of Committee FundsCandidate 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).
This Designation is filed at the Board of Elections office where the committee’s campaign reports are filed.
Candidate Name: ____________________________________________________________
Committee Name: ____________________________________________________________
Treasurer Name: ____________________________________________________________
If Candidate is own treasurer, designate an agent to carry out designations:__________________
Committee ID #: ____________________________________________________________
Level Registered: [State] [County] If county, specify:_______________________________
I, _________________________, 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))
1. ________________________________ __________________________________
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: ______________________________________________
Date: ______________________
CRO-3900 Candidate Designation of Committee Funds