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Amendment <br />Refunds/Reimbursements To the Committee Pg I of 1 ❑ Yes ® No <br />Use this form to report refunds received by the committee or reimbursements fora previous expenditure. <br />I. Committee Full Name and Fund if a licaNe) <br />2. ID Number <br />COMMITTEE TO ELECT PAM ESCOBAR <br />3. Contributor Information ❑ <br />Add ❑ Retrx)ve <br />A. Fit II Nance, N[it iIiii„.kddress \ Phone <br />Gael utie Jt1% 'Llte <br />UWNARRIE BANK <br />25 PALISADE DR NE <br />CONCORD, NC 28025 <br />(704) 262-3855 <br />d. Type of Cnmmittce <br />y. Cnmmeuts <br />[3 Candidate PAC <br />❑ Referendum [I Part} <br />e. Level Registered (Speci(y) <br />h. tiriginal Fspendilurr ]late <br />0b�3012025 <br />Federal County: <br />❑ state ❑ Municipality: <br />i.Original Fspentiirin•e skint <br />$ 60.00 <br />b. dob'litic/Prot'ession <br />c. Employer's NamelSpeeific Field <br />f. Purpose <br />j. flection Sum to Date <br />REFUND OF DORMANT <br />ACCOUNT FEES <br />$ <br />20.00 <br />k. Account Code <br />I. Form of Payment <br />m. In-Kiad Description <br />n. Date (mmlddlyyyy) <br />o. Amount <br />I <br />Electric Funds Tran <br />11/28/2025 <br />40.00 <br />4. Total only this Page <br />$ <br />40.00 <br />5. Total of ALL CRO-1240 Pages <br />(This line must be on line 10 ofDeloiled Summary Page CRO-1100) <br />$ <br />40.00 <br />CRO-1240 NC State Board of Elections December 2007 <br />