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Disbursements <br />Amendment <br />Pg 1 of 1 ❑ Yes ® No <br />Use this form to report expenditures from the committee for operating expenses, c o ntrib ut ia n s to candidate/political <br />corranittees and coordinated vartv exoenditures <br />1. Committee F'ulI Name and land if appi icable <br />2. ID Number <br />COMMITTEE TO ELECT VAN SHAW <br />3. Type of Disbursement Please use separate CRO-1310 fornufareach &a a Di bursemeut. <br />Operating Expenses Contributions to Candidates/Political Committees Ej Coordinated Party Expenditures <br />4. Payee Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Coordinated Committee Name <br />d. Comments <br />CABARRUS COUNTY BOARD OF ELECTIONS <br />369 Church St N <br />CONCORD, NC 28025 <br />c. Level Registered (Specify) <br />13Federal 13 County: <br />❑ State ❑ Municipality: <br />e. 113ection Sum to Date <br />$ 1,773.62 <br />f. Account Code <br />g. Form of Payment <br />h. Purpose Code <br />i. Date (mmlddlyyyy) <br />j. Amount <br />k. Required Remarks <br />1 <br />Check <br />0 <br />12/01/2025 <br />$ 1,773.62 <br />FILING FEE <br />4. Payee Information ❑ Add ❑ Remove <br />a. Ful{Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Coordinated Committer Name <br />d. Comments <br />FARMERS AND MERCHANT <br />635 Church St N <br />CONCORD, NC 28025 <br />c. Level Registered (Specify) <br />0Federal 11 County: <br />❑ State ❑ Municipality: <br />e. )Election Sum to Date <br />$ 490.00 <br />f. Account Code <br />g. Form of Payment <br />h. Purpose Code <br />i. Date (mrrrlddlyyyy) <br />j. Amount <br />k. Required Remarks <br />I <br />Electric Funds Tran <br />0 <br />12/01/2025 <br />$ 490.00 <br />BANK & DORMANT FEE <br />$ <br />5. Total only this Page $ 2,263.62 <br />6. Total of ALL CRO-1310 Pages <br />(This line goes In line 13a ofDelafled Summary Page CRU-1100 if Operating Expenses) $ 2,263 62 <br />(This line goes in line 13b of Detailed Summary Page CRO-1100 if C.ontrib to Candldales/Pofitlral Comm) <br />(This line goes in line 13c of Detailed Summary Page CRa-1-100 if Coordinated Party Expendiftims) <br />7. Purpose Codes (List detailed expenditure code in (h.) above) <br />A* - Media B* - Printing C* - Enndrais ing D -To Another Candidate <br />E - Salaries F'* - Equipment G- Political Party H* - Holding Public Office Expenses <br />I - Postage ,I - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund <br />O* Other <br />* Codes re wire detailed explanation in required remarks field <br />CRO-1310 NC State Board of Elections December 2009 <br />