CRO-2100A Statement of OrganizationNew Amended
g. Next Election Year
Email copy of report notices
Printed Name of Candidate
4. Assistant Treasurer Information
Email copy of report notices
b. Account Code c. Type
b. Mailing Address (include City, State, and Zip Code)
(incl. CRO-3500)
a. Full Name a. Financial Institution Full Name
d. Email Address
November 2019CRO-2100A NC State Board of Elections
Printed Name of Treasurer Signature of Appointed Treasurer Date
I certify that the Committee is in compliance with all applicable provisions of Article 22A 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.
d. Email Address
5. Custodian of Books Information (Keeper of Records)
c. Phone Number d. Email Address
Send report notices by email Yes No
e. Date Organized
Date
b. Mailing Address (include City, State and Zip Code)
c. Phone Number
b. Mailing Address (include City, State and Zip Code)
f. Phone Number
6. Account Information
Email copy of report notices
Signature of Candidate
c. Phone Number
a. Name of Committee
This form must be accompanied by form CRO-3500. An amended form is required for each new election year.
3. Treasurer Information
b. Mailing Address (include City, State, and Zip Code)
d. ID Number
c. Committee Website (Optional)
1. Committee Information
d. Email Address
a. Full Name
c . Phone Number
I certify that the information above is correct, and I, as the candidate, appoint said treasurer to personally fulfill the
duties and responsibilities imposed upon the appointed treasurer and subject to the penalties in Article 22A of Chapter
163 of the NC General Statutes.
Is this statement:Statement of Organization - Candidate Committee
h. Jurisdiction
Use this form to create a new or update an existing candidate committee.
a. Full Name
2. Candidate Information
b. Mailing Address (include City, State, and Zip Code)
a. Full Name
f. Office Sought
e. Party Affiliation