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OutStaIIdIng Loans Amendment <br />rx . � of - ❑ Yes ® No <br />Use Phis form to report mry au wording loans received during a previous reporting period and unil the loan is paid in full. <br />1. Committee Fall. Name and Find if a licable��' x ID Number <br />I)t na, f ee- _/ed. Bl j-� 1 s i1CRK OF &' LL i <br />3. Lender Information ❑ Add ❑ Remove <br />a. Fun Name, Making Address & Phone b. Job'C#IelProlessiou I d. Comments <br />(indudc city, state, & 22p) <br />1+ lLi-;'Tray <br />�'�{��.' e. Start Date (mm/dd/yYYy) <br />1 m 31 Obb 0fRRk07T,-�o6D ` Employces NamelSpedfie Field <br />Cc— L End D2te (mm)dd/YYYY1 <br />Igo -t5Z Ivs-7 <br />g. Rate h. Security Pledged i- original Lem Amount j_ Remairiag I.�n Balance <br />% ca <br />ff , ono 000 <br />k. Fun Name of Leading Insumofion I. Ion Number <br />NO <br />3. Lender Information ❑ Add [] Remove <br />a. FOU Name, Mailing Address & Phone b. Job TidelProfession d. Comments <br />(mclnde city, state, & tifp) <br />y�r�l..il+a►z.- cc.l�i�R�.,�'`�f.�.'`�t9�� �'�;=4��z� �F C'a/(u.,e� <br />[c '5p"k.QS {J`%it fv x e. StartDMc (mm/ddfyM) <br />Employer's Namr/Sspecirw Fiidd <br />�Z�oZCa aofG <br />tV /i [ End bate m/dd/y"y) <br />ago - 5,z -30-q rl 4� IJ] I c (nIV%i <br />g. Bak h. Security Pledged i. Orq"d Ina° Amount <br />j. R—aining [.oan Balance <br />k. Full Name of Lswdtng Iastimtjou L Loan Number <br />3. Lender Information, ❑ Add ❑ Remove <br />a. FUH Name, Msging Address & Phone b. Job TrdelProrawoa d. comments <br />(include city, state, a tip} L',f - <br />L SIC 01= & Lit t' <br />j d,46 � R 4:f7 d W ? 1r a Start Date (mm/ddlyM) <br />l 10 39 o L•D C t�4R d7 fT G c. Employees NamdSperifie F7idd <br />020ncoY-�p hC '�I$ok-2? 07/0?/ O/O <br />/V (l 40C E End Date (mmMdlyyyy) <br />g. Rate h. Secu ty Pledged L Original IOaa Amount i- Remaining Ivan Salaaee <br />boo "6 <br />IL Fun ]Name of Lending b sfit own L L°Wn Number <br />1� <br />4. Totalonly tftis page <br />S. Total of ALL CRO-1430 Pages <br />(This lace must be on 6ne 21 ofDr'tdW semmy Page CEO-lroo) $ 4Ir , � �Q <br />CRO'-1430 NC State Board of Eieeiions f Deccmber 2007 <br />