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Disclosure Report Cover <br />Amendment <br />❑ Yes ® No <br />Use this form for general report and committee information, must be signed and submitted along with other detailed forms. <br />Do not use this form to update information <br />1. Committee Information <br />a. Full Name <br />c. ID Number <br />_.. E c-A <br />C le�k.� CotL►r�" <br />b. Mailing Address (include City, State and Zip Code) <br />d. Date Filed <br />3S kk'Jl F �1eiz G_C F.e_'D f SW{ <br />RLCEIVE❑ <br />[;[3r1CQ`Ccx, l�l C. �2 <br />IN -PERSON <br />e. Phone Number <br />JUL 10 2020 <br />-.!5�l.1 -3i0 <br />2. Report Year <br />3. Period Start Date (mmlddlyy) <br />4. Period IUzi <br />� F ELL <br />NTY <br />measurer Full Name <br />{ramlddl <br />0 -:? <br />U�a�da <br />�rk�► � <br />6. Type of Committee (Check One) <br />9. Type <br />of Report {check only <br />one type of report from one cafe ory) <br />® Candidate Campaign ❑ Party <br />municipal <br />StateJCounty <br />Referendum <br />❑ PAC ❑ Referendum <br />❑ <br />Clrganuational <br />❑ Organizational <br />❑ Ckganizational <br />Independent ❑ Joint Fundraiser <br />❑ Expenditure <br />❑ <br />Thirty -live day <br />Quarterly <br />❑ Pre -referendum <br />❑ Legal Expense Fund <br />❑ <br />❑ <br />Prc-primary <br />Pre -election <br />❑ First <br />❑ Second <br />❑ Final <br />❑ SupplementaI Final <br />7. T e of Fund (if applicable, check one) <br />❑ "Booster Fund" <br />[] Building Fund <br />❑ <br />Prc-runoff <br />❑ Third <br />❑ Annual <br />Semi-annual <br />❑ Fourth <br />❑ Special <br />C-17 <br />Mid Year <br />Semi-annual <br />❑ Other_ <br />❑ <br />Year End <br />® Mid Year <br />10. Special Report Name <br />❑ <br />❑ <br />Final <br />Special <br />❑ Year End <br />❑ Final <br />❑ Special <br />S. Number of Fundraisers this Report <br />_ <br />11. Account Information <br />11. Account Information <br />a. Financial Institution Full Name <br />a. Financial Institution Full Name <br />tt S4�. �rn c'P_s <br />b. Purpose <br />c. Account Code <br />b. Purpose <br />e. Account Code <br />q <br />d. Period Begin Ra18nce <br />d. Period Rgon Balance <br />7t e-na i t' u-Ye—S <br />P <br />CERTIFICATION <br />I certify that the Committee or Fund is in compliance with al I applicable provisions of Article 22A, 2213, & 22D-22M of Chapter 163 of <br />the NC General Statutes and that no funds are commingled <br />with prohibited or other non -disclosed funds. 1 fturther certify that this report <br />is complete, true and correct and that I have been trained <br />t� <br />by the NC Slate B of Elections. <br />Lc1 <br />Printed Nance of Signer _ <br />_Signature of Appointed Treasurer <br />� Of ate <br />FOR OFFICE USE ONLY <br />Date Received: ' 1 <br />Employee: gL�_LDelive <br />Method <br />❑ Normal Mail <br />Date Postmarked: <br />Employee: <br />❑ Registered Mail <br />[}wand Delivered <br />, <br />�mm <br />❑ Electronically piled <br />Date Scanned: <br />Employee: WOK <br />❑ Signer has not received <br />mandatory training <br />Date Data Entered: <br />Employee: <br />Please Note: This form cannot be used to amend committee information such as the committee address, treasurer, assistant treasurer, <br />custodian of books information, or account information. <br />You must amend the Statement of Organization (CRO-2IOOA-E) to make committee changes. <br />CRO-1000 NC Slate Board of Elections August 2008 <br />