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Amendm <br />Disclosure Report Cover 0 yes ❑ No <br />Use this form for general report and committee information, must be signed and submitted along with other detailed forms. <br />Dfo not ime. this fnrm to nnrlale. inform9tion- <br />1. Committee Information <br />a. Full Name <br />c. ID Number <br />Fed 6-, <br />b. Nfailing Addrrpes, (includc City, StateandZip Code) <br />d. Date Filed <br />-A) C _ S ? 5 <br />e. Phone Number <br />2. Report Year <br />3. Period Start Date (mtnlddlyy) <br />4. Perod_End. Date (mmlddlyy) . <br />5. Treasurer Full Name <br />L. pe of Committee (Check One) <br />9. Type of Report (check <br />onPy one type of report <br />from one category) <br />Lj Canchdatc Campaign ❑ Party <br />Municipal <br />State/County <br />Referendum <br />❑ PAC ❑ Referendum <br />❑ Organizational <br />❑ Organizational <br />......_....................................................................................... ..... <br />❑ Organizational <br />❑ Independent Expendintre ❑ Joint Fundraiser <br />❑ Thirty-five day <br />Quarterly <br />❑ Pre -referendum <br />❑ 1.egxi Expense Fund <br />❑ Pre-primary <br />❑ Fint <br />❑ Final <br />❑ Pre -election <br />❑ Pre -runoff <br />❑ Second <br />❑ Third <br />❑ Supplemental Final <br />❑ Annual <br />7. Type of Fund (+f 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 />❑ ❑[her; <br />❑ Final <br />❑ Special <br />Year End <br />❑ Final <br />$. Number of Fundraisers this Report <br />❑ Special <br />11. Account Information <br />11. Account Information <br />Financial Institution Full Name <br />a. Financial Institution Full Name <br />ff <br />vv -� <br />.................................. _... ......... <br />b. Purpose <br />c. Account Code <br />h. Purpose IN -PERSON <br />c. Account Code <br />JAN 2 3 2026 <br />d. Period Begin Balance <br />d. Perind Hkjin Balance <br />CABARRUS CCLINTY <br />$ l C+p. d0 <br />BOARD OF EXEC IONS <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 Board of Elections. <br />�P, wd. — 1 /z--?/ ?- <br />e) . u <br />� <br />Printed Name of Signer Signature of ApWinted Treasurer Date <br />OR OFFICE USE ONLY <br />}� <br />3 WAN Delivery Method <br />Date Received: Employee: <br />❑ Normal Mail <br />[3 Registered Mail <br />Date Postmarked: Employee: <br />® Hand Delivered <br />h� ❑ Electronically Filed <br />Date Scanned: Employee: <br />Date Data Entered: Employee: ❑ Signer has not received <br />mandato training <br />Please Note: This form cannot be used to aanend 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 I OOA-E) to make committee changes. <br />CRO-IUUU NC State Board of Elections August 2UU2S <br />