01_Beatty Committee FormsAmendment
Statement of Organization -Candidate Committee Cl Yes 6No
Use this fonn to create a new or update an existing candidate committee.
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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 funds are commingled with prohibited or other non-disclosed funds. I
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'-'/Printed Name of Signer Signature of1\fpointed Treasurer
CRO·2100A NC State Board of Elections December 2007 RECEIVED
FEB 16 Z01Z
RECEiVED
North Carolina FEB 1 6 20'2
State Board of Elections
506 N Harrington Street
Raleigh, NC 27603
Kimberly Westbrook-Strach
Deputy Director -Campaign Reporting
NHC Be! ot Elections
Mailing Address
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:
(include city, state, & zip)
Treasurer Phone:
I certify that the above information is correct, and I, 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 VIII. Regulation of Election Campaigns of Chapter 163 of the North Carolina
General Statutes.
I 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 three months of this
appointment according to Article 163.278.9(k).
Note: This Certification is to be filed at the Election Board where the committee's campaign reports are filed.
CRO-3iOO Certification of Treasurer June 2007
Kimberly Westbrook-Strach
Deputy Director -Campaign Reporting
North Carolina
State Board of Elections
506 N Harrington Street
Raleigh, NC 27603
RECEIVED
FEB 16 2012
NHC Bd of Elections
Mailing Address
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: Kg reM.. (:10..1 beo.-tl--y _
Committee Name: c..olYlW\i&e. fp ~Je.c.+ Kay=eNt (!]CA.¥ Beatty __
Treasurer Name: Etr/"ill. /J,'X.tH'\
If Candidate is own treasurer, designate an agent to carry out designations: _
Committee ID #: 5 J+A H 13
Level Registered: [State] [County] If county, specify: /\/e.w Hall f)'t€. r CQunty
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(Name of Candidat )
hereby direct that in the event of my death or incapacity all
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/rom §163-278.16B(a»
1. ~M i "j1mTen Foul'lda~
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:
Note: This Designation is to be filed with the Election Board where the committee's campaign reports are filed.
CRO-3900 Candidate Designation of Committee Funds June 2007