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01_Zapple Commitee FormsAmendment Statement of Organization - Candidate Committee ❑ Y. EgN. Use this form to create a new or update an existing candidate committee. This form mn.0 hencr.ornnanied by fnrmg CRO-3 100 and CRO-3500 (when amending. only re-submit if aDDlicable). 1. Committee Information Full Name c. 11D Number Zappleforcommissioner2012 D Z RECEIVEF.�, SHAGS b. Mailing Address (include City, State and Zip Code) d. Date Organized O. Box 1987, Wilmington, NC 28402 NHC Bd of Elections e. Phone Number 910-622-3569 2. Candidate Information ❑ Candidate's Primary Committee a. Full Name ---------- e. Candidate ID Number E Party Affiliation Democrat Robert Zapple (Indicate Non-partican if applicable) b. Mailing Address (include City, State, and Zip Code) g. Office Sought 321 R.L.Honeycutt Dr., Wilmington, NC 28405 County Commissioner c. Phone Number d. Email Address h. Next Election Year i. Jurisdiction 910-619-2464 obzapple@yahoo.com t New Hanover County ❑ Email copy of notices 3. Treasurer Information 4. Custodian of Books Information a. Full Name a. Full Name Lee Lowrimore b. Mailing Address (include City, State, and Zip Code) b. Mailing Address (include City, State, and Zip Code) 1716 Chestnut St., Wilmington, NC 28405 c. Phone Number d. Email Address c. Phone Number d. Email Address 910-622-3569 Llowrimore@ec.ff.com I prefer to receive notices by email Yes No [3 Email copy of notices 5. Assistant Treasurer Information M -Add 6. Account Information ftnel. CRO-3506, Add a. Full Name 1:3 Remove a. Financial Institution Full Name b. Mailing Address (include City, State, and Zip Code) b. Purpose Phone Number d. Email Address c. Account Code d. Type E3 Email copy of notices CERTIFICATION 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 ith prohibited or other non-disclosed funds. I further certify that this report is complete, true and correct. Lee Lowrimore 3/15/2012 Printed Name of Signer Signature of Appointed Treasurer Date CRO-210" NC State Board of Elections may 201 i North Carolina State Board of Elections 506 N Harrington Street Raleigh, NC 27603 Kimberly Westbrook- Strach Deputy Director — Campaign Reporting RECEIVED MAR 0 9 20112 NHC Bd of Elections Certification of Treasurer Mailing Address PO Box 27255 Raleigh, NC 27611 -7255 (919) 733 -7173 Fax: (919) 715 -8047 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) Jti[ l� �� Gam• r1 `a yt.at. 2 ��/G� S� Treasurer Phone: 0 t 07 6 Z Z — 3 S-Gq 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). c" 3 -1--/2 Date Signed Signature o Note: This Certification is to be filed at the Election Board where the committee's campaign reports are filed. CRO -3100 Certification of Treasurer June 2007 J Sth1t Tti North Carolina State Board of Elections 506 N Harrington Street Raleigh, NC 27603 Kimberly Westbrook - Strach Deputy Director — Campaign Reporting FRIE GCED MAR a 9 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: Committee Name: -A a o,©% 4r- G ht.K.'ssr yaf✓' 7-012- Treasurer Name: l+4e- /-% i^� •rt ®yt If Candidate is own treasurer, designate an agent to carry out designations: NZIA If Committee ID #: r Level Registered: [State] Count} l If county, specify: Cac4ot 7�„ hereby direct that in the event of my death or incapacity all (Name of Candidate)/ r 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 (Select from §163- 278.16B(a)) 1. /hat•>r.a �K� /CiK7��ertt»ave j's ^ • t�or � s 4 c 2. c1 Plan for Disbursement (eg. Amount or %) OU 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: Is -4 -12 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