Uzcategui 2021 Organizational Formstatement of organization - candidate committee
Use this form to create a new or update an existing candidate committee.This form must be form CRO-3500. An amended form is for each new election
statement:
New
Name
ID
Date
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Commilhs Website (Optional)
Phone Number
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Full Neme Affilirtion
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Mailing Address (include City,Stete, end Zp Code)
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Offic.e Sought
. Phone d. Emril Addr.ess Ncrt Election Yeer Jurisdiction
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FulINem Full Name
Address State andt3
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Phone Number Address Phone Number Eruail Address
notices Yes No
Neme
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Address artdOr'fW*et'tetnt,3q LI
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Phone Number d Emeil Address Accouot Code T}?e
Email of notices NHC BD OF EI.ESNONS
funds are commingled with prohibited or other non_disclosed
Printed Name of Treasurer Signature of
yl
Treasurer Date
Printed Name of Candidate
I certify that the Committee is in compliance with all applicable provisions of Article 22AofChapter 163 of the NCGeneral Statutes and that no funds. I further certi$ thatthis report is complete, true and correct.
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treasurer to personally fulfill the
penalties in Article 22A of Chapter
saidthethatcertifyinformationaboversandascorrect,theI,candidate,appoint
and responsibilities theimposedupon andtreasurerappointed to thesubjectof63theNCGeneralStatutes.
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