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Statement of Organization - Candidate Committee | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Amendment | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes |  |  | No
Use this form to create a new or update an existing candidate committee.
This form must be accompanied by forms CRO-3100 and CRO-3500 (when amending, only re-submit if applicable).
1. Committee Information
a. Full Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | c. ID Number
[NAME] (include City, State and Zip Code) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | d. Date Organized
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | e. Phone Number
2. Candidate Information |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Candidate's Primary Committee
a. Full Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  | e. Candidate ID Number |  |  |  |  |  |  |  | f. Party Affiliation
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | (Indicate Non-partican if applicable)
[NAME] (include City, State, and [NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  | g. Office Sought
c . Phone Number |  |  |  |  | d. Email Address |  |  |  |  |  |  |  |  |  | h. Next Election Year |  |  |  |  |  |  | i. Jurisdiction
Email copy of notices
3. Treasurer Information |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4. Custodian of Books Information
a. Full Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  | a. Full Name
[NAME] (include City, State, and [NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] (include City, State, and [NAME])
c. Phone Number |  |  |  |  | d. Email Address |  |  |  |  |  |  |  |  |  | c. Phone Number |  |  |  |  | d. Email Address
I prefer to receive notices by email            Yes           No |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Email copy of notices
5. Assistant [NAME] |  |  |  |  |  |  |  |  |  |  |  | Add |  |  | 6. Account Information |  |  |  |  |  |  | (incl. CRO-3500) |  |  |  |  | Add
a. Full Name |  |  |  |  |  |  |  |  |  |  |  | Remove |  |  | a. Financial Institution Full Name |  |  |  |  |  |  |  |  |  |  |  | Remove
[NAME] (include City, State, and [NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]
c. Phone Number |  |  |  |  | d. Email Address |  |  |  |  |  |  |  |  |  | c. Account Code |  |  |  |  | d. Type
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 with prohibited or other non-disclosed funds.  I further certify that this report is complete, true and correct.
 | Printed Name of Signer |  |  |  |  |  |  |  |  |  |  | Signature of Appointed Treasurer |  |  |  |  |  |  |  |  |  |  |  | Date
[NAME] |  |  |  |  | NC State Board of Elections |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2011-05-11 00:00:00