Loading...
Zapple 2021 Organizational Form AmendmentStatement of Organization - Candidate Committee Use this form to create a new or This form must be Is this statement: I rew E Amendeo new election tc)*ffit' Nt{o ED ol:t€CItoNg Commltec Wcbdte r+tn$-9065 rnd&Code)Ofice $ought Pteuellder Nert Elecfion Year d. 7 Nuder D4 Jurlrdlcdoa I ,ttHc d"Addrorr Mdl@Addrarc (trolde Cltf, 2t L. 6HA.aSS-C. btz Ur{c I\[eme 8t8te lfu,n tPMclfrfficr Emrll Addre* I {*t Pa#As D l"l *? Ptoec Number EurllAddtesr Email of a S t1+1. S*. Accollnt c.typeEudl AddrersPhG 'lfli1 Email of notices 1p**k Ct-.*;e* Signature of Printed Name of Candidate f Treasurer Date ofCandidate Date Printed Name of Treasurer Drr.t correct. I certifo that the Committee is in compliance with all applicable provisions of Article 22A of Chapter 163 of the NCGeneral Statutes and that no fi,urds are commingled with prohibited or other non_disclosed funds. I further certifu thatthis report is complete, true and NTf D thethat informationcertify above is andcorrect,theasI,candidate,saidappornt treasurer to tulfill thepersonallyandresponsibilitiestheuponimposedappointedandtreasurertothesubjectinpenaltiesArticleof22AChapter63theofGeneralNCStatutes. tltlzr NC State of Elections 201 form CRO-3500. An amended tto Con 9 ?,r,hs Dlxou 2 l^t L-iI l,rC ;:: t .i7 /, ' .r,,..1tt;..,i1 -rt 4d:rta, li. "atr'.a:t.. .'1:,:;', ': I - I