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Statement of Organization - Candidate Committee 1s this statement: <br />NNov ■mended <br />Use this form to create a new or update an existing candidate committee. <br />This form must be accompanied by form CRG-3500. An amended form is required for each new election year. <br />1. Committee Information <br />a. Name of Committee <br />d. Ill Number <br />Committee to Elect Jeff Gofotli <br />h. Mailing Address (include City, State and 'Zip Code) <br />- <br />e. Date Organized <br />2887 Shady Lane Ave. <br />Concord, NC 28027 <br />6/8/2026 <br />C. Committee 11'ebsite (Opti(nal] 1'. ]'hone Number <br />Committee to Elect Jeff'Gofoth 704-475-0187 <br />2. Candidate Information <br />;L. Pull Name <br />e. Party AFIiliation <br />Jeff Goforth <br />b. Mailing, Address (include City, State, and Zip Code) <br />f. office Sought <br />2887 Shadv Lane Ave. <br />Concord, NC 28027 <br />Soil & Water Conservation 1)islricl Supervisor <br />c . Phone Nmnber <br />d. Email Address <br />g. Next Election Year <br />It, Jurisdiction <br />704-475-0187 <br />jeffiic73@gmail.com <br />2026 <br />Cabarrus County <br />❑ Email coy of report notices <br />3. Treasurer Information <br />4. Assistant Treasurer Information <br />a. Full name <br />a. Full Name <br />Jeff Goforth <br />NIA <br />Ia. NIaiiing Address (include City, State, and Zip Code) <br />b. Mailing Address (include City, Stale, and Zip Code) <br />2887 Shady Lane Ave. <br />Concord, NC 28027 <br />c. Plmne Number <br />d. Email Address <br />c. Phone Nuui6rr <br />d, F,aaail Address <br />704-475-0187 <br />jeffhc73 rr gmail.com <br />Send report notices by email I I Yes IX]No <br />❑ Email copy of report notices <br />5. Custodian of Books Information (Keeper of Re <br />6. Account Information (incl. CRO-3500) <br />a. full Name <br />a. Pimaucial lustitution Full Narlre <br />NIA <br />WCEIVED <br />b. NIailing Address (inclarde City, State, and Zip Code) <br />b. Purpose <br />- JUN 0 8 2026 <br />C. Phone \umber <br />d. E:rnail Address <br />b. Account Code <br />c.'IWARRUS C. UN-ry <br />BOARD OF ELECTIONS <br />Email copy of report notices <br />I certil'y that the Committee is in compliance with all applicable provisions of Article 22A of Chapter 163 of <br />the NC General Statutes and that no funds are commingled with prohibited or other non -disclosed funds. I <br />further certify that Ili is report is complete, true and correct. <br />Printed Name of Treasurer ignature of Appointed Treasurer Date <br />I certify that the information above is correct, and 1, as the candidate, appoint said treasurer to personally fulfill <br />the ditties and responsibilities imposed upon the appointed treasurer and subject to the penalties in Article 22A <br />of Chapter 163 of the NC General Statutes. <br />Printed Name of'Candidatc , ignature of Candidale Date <br />CRO-210" NC Stale Board ol' Elections Novernber 2019 <br />