Laserfiche WebLink
0 <br />VOTE <br />�11T� <br />NORTH CAPOLINA <br />STATE BOARD OF ELECTIONS <br />Loan Proceeds Statement <br />This Statement is used to report detailed information about a new loan and is required to accompany the <br />Loan Proceeds Form in the report for which the loan is initially disclosed. If the loan is from an individual, <br />the lender's signature is required on this form. <br />This Statement is to be filed with the Election Board where the committee's reports are filed. <br />• <br />Name of committee to receive loan.& bm i t7- iSh 1 <br />• <br />Person or committee to make loan: _U611,e ll lAld1 i a f"S <br />• <br />Date of loan to committee: 314 z[v , '311 Lb <br />• <br />Name of lending institution (source): <br />• <br />�G <br />Amount of Ivan: 6' (0d <br />• <br />Description (if in -kind loan): <br />• <br />Names of all parties responsible for payment of loan (guarantors): <br />• <br />Period of loan: `//a Cu 127 <br />• <br />Rate of interest of loan: <br />• <br />Security pledged for loan: <br />I, r 112E lff _6 1 /r__ar`� acknowledge that all of the information <br />(Person lending money to committee) <br />provided is complete, true, and accurate. I further understand I may not forgive a loan <br />that has an outstanding balance to any source. <br />Sig ture of Len Date Signed <br />y <br />Treasurer of Committee <br />CRO-6100 Loan Proceeds Statement <br />Date Signed <br />