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Outstanding Loans <br />Amendment <br />PC of 0 Yesc © No <br />Use this form to mport any ouWumding loans reeeived ding a previous reporting period and urtfil the Ioen is paid in hell. <br />L Comwi6tee FnH Name wd Fmd if a hica#rle <br />L ID rlwWbe r <br />�ornm I-e, Ere.+ i 4►-3a��s �L��t4 C.a <br />3 Lender Information ❑ Add ❑ Remove <br />L FUR Name, Mating Address & Phone <br />City, state, & zip) <br />b. Job ThkYrrolesshm <br />d. Casmmeats <br />p i cptc yt, <br />[[ ��(Include <br />{ fA 3 D 4 <br />,►,,� o �� , fJ G a Soy <br />e. Sun Date (glw/ddiyyyy) <br />e; F—ploye s NawuWSp�esi6c Ftdd <br />4 C P+vG <br />r Fad Date (mmiddlyyyy) <br />13 <br />& late <br />b. y Plea <br />L Origin Loan A.mammt <br />J. Rewaftft 1=118ahwe <br />o%YJR <br />k. FnH Nmw of Lntding Ins6luth m <br />L Lou Nowber <br />3. Lender Information ❑ Add ❑ Remove <br />a. Full N sae; Matting Address & Pbone b. Job TitldYm%sseun <br />(indwiccity, states & zip) �cL-�i{ o-S cytUCA- <br />ts.�- i A n. �R APtAEN t`-9;,.+� �A $ t_.a���.xylk S <br />Mt r'lln s3dg o t C�,�A C. Fmptoyeex N�dspee�t FxHI <br />900 PenoI or Rm 104 <br />Lonacw"i NG a 90as NC R o G <br />g. R h-y L l Loan Ater <br />0 % <br />k. FwH ]+lame of Lending laadtatirm <br />1pt <br />3.-Lender. ation ❑ Add ❑ Remove <br />d. Cows als <br />e- 519rt Date (ms�lddl79]ryl <br />1 a lob f apA <br />L End Date (Hnldd"y) <br />� R <br />;. Tiemaai8g r oa,a Balance <br />�! pDC� cry <br />L Lana Namber <br />a. Fall MMW. MIAIhg Address & Phone <br />(tacitlde dty, adttty & rip] <br />b. Job Irdieftefe ssion <br />d. Cona mts <br />e. Shirt Darr (w&ldit y) <br />e; Eaiplosyer's Name Fleld <br />L End Date (mmlddlyyyy) <br />& Rate <br />b. Seem* Pledged <br />L DrigW Load Amount <br />J. Rcun iaing moan Eabume <br />% <br />$ <br />L Fall Nuw of I.ambeg laWkeffi a <br />L Loan Naaaber <br />4. Total #iris LlaLe $ <br />S. Tots] of ALL CRO-1434 Pages <br />ahk fim must bear Hm..2I ®fBdaiied&riw"y Page CRO-1100) <br />CRO-1430 NC State Board of Flecdws December 2007 <br />