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Outstanding Loans <br />Amendment <br />Pg 3 of _- ❑ Yea © No <br />Use this form to report any outstanding loans received during a previous reporting period and until the loan is paid in full. <br />1. Committee Name and Fund if a linable <br />x. ID Number <br />�FuR <br />,t <br />ODMM',-10-e- -6 Eke.c-� �J t��- i��c�`]5 L4e—<k Couyf <br />3. Lender Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Job TitkWrofession <br />d. Comments <br />L.��-Y':wS �..^� tL'(1Y <br />Wi4.t11�� W A}RR�tu ��[��--Y s <br />��c+�-t t'�c� S ��- C3� <br />1 <br />soo N."o [.��� WI �RfA �o� <br />��� C a Sod <br />e. start Date (mmddlyyyy} <br />c. Employer's Name/Specifc Field <br />o t j 31 <br />11 C A oG <br />f. End Date (mmlddlyyyy) <br />a <br />Z. Bate <br />h. Security Pledged <br />i. Original Loan Amount <br />j. Remaining Loan Balance <br />o <br />`Y r� <br />$ aC 1 0C>0 � <br />$ � 7 C cx) <br />k. Full Name of Ltudiag Institution <br />I. Loan Number <br />114 <br />3. Lender Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Pbone <br />(include city, state, & zip) <br />b. Job TigeWrofession <br />d. Comments <br />�t US.- <br />ca bo'w" cow'ky <br />w ij.--1 PrrV% Lfi P'PZW T3x,.jq S <br />m o: {)k r)q Side— <br />70o Qnn�L�ne ts- �',m !b4 <br />CI _ nco� fd' g� � <br />e. Start Date (mmlddlyyyy) <br />c. Employer's NamclSpecific Field <br />! a <br />p <br />f. End Date (mmlddlyyyy) <br />R <br />g. Rate <br />h. Security Pledged <br />L Original Loan Amount <br />j. Remaining Loan Balance <br />% <br />R <br />$ ,ovo. <br />-�lono , <br />k. Full Name of Lending Institution <br />L Loan Number <br />ft <br />3. Lender Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b- Job Title/Profession <br />d. Comments <br />e. Start Bate (mmlddlyyyy) <br />c. Employer's Name/Specific Field <br />f. End Date (mmlddlyyyy) <br />g. Rate <br />b. Security Pledged <br />L Original Loan Amount <br />j. Remaining Loan Balance <br />% <br />$ <br />$ <br />li Full Name of Lending Institution <br />1. Loan Number <br />4. Total only this Pa e $ �•c . <br />S. Total of ALL CRO-1434 Pages <br />$ <br />(This line must he on lure 21 ajllelaf aSurnmary Page CRQ1100) <br />CR&1430 NC State Board of Flections December 2007 <br />