Laserfiche WebLink
I Amendment <br />D i scl o sur e R epo rt C o v e r D vs t No <br />U se th is fo rm fo r gen eral rep o rt an d co mmittee info rmat ion ,mu st b e signed an d su b mitted a lo n g wit h o t h er d eta iled fo rms. <br />Do n o t u s e t h is fo rm t o u p d at e info rmat io n <br />JUL <br />1.Committee Info rma tio n <br />a.Full Name •ID Number <br />Cn m«H elo lee+Ba-co 'LR or ur <br />b.Mailing Address (include City,State and Zip Code)d.Date Filed <br />3945 ent C eek D.S u <br />Co ncod,N C a&0 3 71 e.Phone Number <br />I <br />830-521-317 <br />2 .Repo rt Year 3 .Perio d Sta rt Date (nm/dd/yy)4 .Period End Date 5.Treas urer Full Na me(mm/dd/vv) <br />401s o//a0as o6/30/a 0s hand H•hhs <br />6 .Type o f Committee (Ch eck One)9 .Ty pe o f Repo rt (ch eck o n ly on e tvp e o f rep o rt fro m o ne ca t ego ry ) <br />O Candidate Cam pai gn □Party Municipal State/County Referendum <br />□PAC □Referendum u Organizational LJ Organizational u Organizational <br />□Independent □Joint Fundr aiser □Thirty-five day Quarterly □Pre-referendumExpenditure□Legal Expense Fund <br />7.Type o f Fund (if applicable,check one)□Pre-primary □First □Final <br />LJ "Booster Fund"□Pre-election □Second □Supplemental Final <br />□Building Fund □Pre-runoff □Third □Annual <br />Semi-annual □Fourth □Special <br />□Mid Year Semi-annual <br />□Other.□Year End Ki Mid Ycar 10.Special Repo rt Na me <br />□Final □Year End <br />8 .Num ber o f Fundra isers this Report □Special □Final <br />□Special <br />11.Acco unt Info rmatio n 11.Account Info rmation <br />a.Financial Institution Full Name a.Financial Institution Full Name <br />g4.{>Lloree (Cr el!+]Yo n <br />b.Purpose I I c.Account Code b.Purpose c.Account Code <br />Can paq o E 1Reel+>'d.Period Begin Balance d.Period Begin Balance <br />Ex pe n d /'lures <br />$],3 9 8 4 7 $ <br />CERTIFICATION <br />I cert ify t ha t t h e Co mmittee o r Fund is in co mp lian ce wit h aU ap p licab le p ro vis ion s o f Artic le 2 2 A,2 2 B,&2 2 D-22 M o f Cha p te r l 6 3 o f <br />the NC Ge n eral Sta tutes an d th at no fund s are co mmingled wit h p ro h ibited o ro th~rn n-disc lose d fund s.I further cert ify that t h is rep o rt <br />is co mp leli/4te true an d co rrect an d that I h av e b een tra ined b y th er)%ta t e:~ard o f':~1JwA_-1l/4.1/20:l3AndaHt,Ah 2 8 <br />Printed Name of Signer Signature of Appointed Treasurer T Date <br />FOR OFFICE USE ONLY <br />G 1lasDateReceived:E mp loy ee:-tc De liv ery Met h o d <br />□Normal Mail <br />Da te Po stmark ed :E mp loy ee:□Regis tered Mail <br />~ <br />H an d De liv ered <br />Da t e Scanned :Employ ee:Electro nically Filed <br />D Sign er h as n o t received <br />Da te Da ta En te red :Employ ee: <br />man da t o ry tra ining <br />Plea se No te :Th is fo rm can n o t be u sed to amen d co mmitt ee info rmatio n su ch as th e co mmittee ad d ress,treas urer,as sista n t t reasu rer, <br />cu st o d ia n o f b o o k s info rmat io n ,o r acco unt info rmat io n .et RECEIVEDi':IN-PERSON ··.,5 <br />Yo u must amen d the Sta t emen t o f Organizatio n (CRO -2 10 0 A -E )t o mak e co mmittee ch an ges .-«- <br />CR0-1 0 0 0 NC State Board of Elections «14298s209%- <br />CABARRUS COUNTY <br />BOARD OF ELECTIONS