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Amendment <br />Disclosure Report Cover o Yes o- 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 undate information. <br />1. Committee Information <br />• . Full Name <br />c. 11) Ntunhcr <br />b. Mailing Address (include City, State and Zip Code) <br />d. Date Filed <br />u tV [�tl YlL7 �C�S <br />e. Phone Number <br />2. Report Year <br />3, Period Start Date (mwddvyy) <br />4. Period End Date (tnn>tdd/vy) <br />5. Treasurer Full Name <br />- - -- ............... _........... <br />_ <br />6 Type of Committee (.Check One) <br />9. Type of Report (check <br />only one type of report <br />fi•orn one category) <br />CanditlateCaIII paign ❑ Party <br />Municipal <br />statetcounty <br />Referendum <br />❑ PAC ❑ Referendum <br />❑ Organizational <br />❑ Organizational <br />❑ Organizational <br />❑ Independent Expenditure ❑ Joint Fundraiser <br />❑ Thirty-five day <br />Quarterly <br />❑ Pre -referendum <br />❑ Legal Expense Fund <br />❑ Pre-primary <br />❑ First <br />❑ FinaI <br />❑ Pre -election <br />❑ Pre -runoff <br />❑ Second <br />❑ Third <br />❑ Supplemental Final <br />❑ Annual <br />7. Type of Fund (if applicable, check one) <br />❑ Booster Fund <br />Semi-annual <br />❑ Fourth <br />❑ Special <br />❑ Building Fund <br />❑ Mid Year <br />Semi-annual <br />Year End <br />Mid Year <br />10. Special Report Name <br />❑ Urlier: <br />❑ Final <br />❑ Special <br />Year End <br />❑ Final <br />8. Number of Fundraisers this Report <br />❑ Special <br />11. Account Information <br />11. Account Information <br />. Financial Institution Fu11 Nante <br />a. Financial Institution Full Name <br />F* P, <br />r MC F.IVED <br />b. Purpose <br />c. Account Code <br />b. Pjrrpose I <br />c. Acxuunt Code <br />e. K <br />JAN L ' 2026 <br />. EW <br />d. Period Begin BalanceCAB'r <br />d. Period Begin Balance <br />$ ' etv Z]• <br />BOAR: �� C i EONS <br />$ <br />CERTIFICATION <br />I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 22D-22M of Chapter 163 <br />of the NC General Statutes and that no funds are commingled with prohibited or other non -disclosed funds. I further certify that this <br />report is complete, true and correct and that I have been trained by the NC State Hoard of Electio <br />fat l l ► �-r... >� a. r� �ti � r - �.Z- � 7...� <br />Printed Name of Si gnei Si nature nl Appomicd Trcasurcr Date <br />FOR OFFICE USE ONLY <br />f� <br />WAN Delivery Method <br />Date Received: Employee: <br />❑ Normal Mail <br />❑ Registered Mail <br />Date Postmarked: Employee: <br />® Hand Delivered <br />- z6 a#Mi ❑ Electronically Filed <br />Date Scanned: Employee: <br />not <br />Date Data Entered: Employee: ❑ mlandato yer has t aniirecglued <br />Please Note: This form cannot be used to amend committee information such as the committee address, treasurer, <br />assistant treasurer, custodian of books information, or account information. <br />You must amend the Statement of Organization (CRO-2 100 A -E) to make committee changes. <br />CRO-I UUU NC State Board of Elections August 2008 <br />