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290R <br />VOTE <br />rTTI� <br />NORTH CAROLINA <br />STATE BOARD OF ELECTIONS <br />Candidate Designation of Committee Funds <br />This form is used by candidate committees only and allows the candidate to designate in the event of their death, <br />how the committee's funds are to be disbursed using the eight allowable methods outlined in 163-278.16B(a). <br />This Designation is filed at the Board of Elections office where the committee's campaign reports are filed. <br />Candidate Name: James Robert Kirk <br />Committee Name: Committee to Elect Robert Kirk <br />Treasurer Name: <br />If Candidate is own treasurer, designate an agent to carry out designations: NIA <br />Committee ID#: <br />Level Registered: [State] [Count3j, If county, specify Cabarrus <br />I, James Robert Kirk hereby direct that in the event of my death or incapacity all <br />{Name orCandi&te) <br />funds remaining in my Campaign Committee account(s) (after payment of permitted outstanding <br />debts or reasonable expenses for winding up the Committee or closing office) be paid in the <br />following manner as permitted by N.C. Gen. Stat. 163-278.16B(a). <br />Name of Entity <br />(Select from §I63-278.16B(a)) <br />1. Cabarrus County Education Foundation <br />2. Dream On 3 <br />3. <br />Plan for Disbursement (eg Amount or %) <br />50% <br />50% <br />By signing this form, I certify that the foregoing entities are eligible beneficiaries under N.C. <br />Gen, Statute 163-278.16B(a). A copy of this form should be maintained with the Committee <br />records. <br />Signature of Candidate: <br />Date: <br />CRO-3900 Candidate Designation of Committee Funds <br />