Laserfiche WebLink
Disclosure Report Cover <br />Amendment <br />0 Yes ® No <br />Use this form for general report and committee information, must be signed and subrrnitted 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 />COMMITTEE TO ELECT VAN SHAW <br />b. Mailing Address (include City, State and Ii1) Code] <br />d. date riled <br />616 IRISH POTATO ROAD <br />01/16/2026 <br />CONCORD, NC 28025 <br />e. Phone Number <br />2. Report Year <br />3. Period Start Date (in mlddlyy) <br />4. Period End Date (mmlddlyy) <br />5. Treasurer Full Name <br />2026 <br />01 /01 /2023 <br />12/31 /2026 <br />VAN SHA W <br />6. of Committee (Check One) <br />9. Type <br />of Report (check only one type of report from one category) <br />® Candidate Campaign ❑ Party <br />Municipal <br />State/County <br />Referendum <br />❑ Joint Fundraiser ❑ PAC <br />❑ <br />Organizational <br />© Organizational <br />© organizational <br />❑ referendum Legal Expense Fund <br />[] <br />❑ <br />❑ <br />Thirty-five day <br />Pre-primary <br />Pre -election <br />Quarterly <br />❑ First <br />❑ Second <br />[] Pre -referendum <br />❑ Final <br />❑ Supplemental Final <br />7. Type of Fund (if applicable, check one) <br />❑ "Booster Fund" <br />❑ Building Fund <br />❑ <br />Pre -runoff <br />❑ Third <br />❑ Annual <br />❑ Presidential Election Year Candidates Fand <br />Semi-annual <br />❑ Fourth <br />❑ Special <br />❑ NC Public Campaign Financing Fund <br />❑ <br />Mid Year <br />Semi-annual <br />❑ <br />Year End <br />❑ Mid Year <br />10. Special Report Name <br />❑ Other: <br />❑ <br />❑ <br />Final <br />Special <br />❑ fear End <br />❑ final <br />❑ Special <br />1 <br />8. Number of Fundraisers this Report <br />0 <br />3. Account Information <br />3. Account Information <br />a. Financial Institution Full Name <br />a. Financial Institution Full Dame <br />F&M BANK <br />b. Purpose <br />e. Account Code <br />b. Purpose <br />c. Account Code <br />CAMPAIGN <br />1 <br />IN -PERSON <br />JAN 16 2026 <br />d. Period Begin Balance <br />d. Period Begin Balance <br />$ <br />$ <br />CABARRUS COUNTY <br />CERTIFICATION <br />I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 22D-22M of <br />Chapter 163 ofthe NC General Statutes and that no funds are commingled with prohibited or other non -disclosed <br />funds. I further certify that this report is complete, <br />true and correct and that I have been trained by the NC State Board <br />n 01/16/2026 <br />Printed Name of jgner <br />Sign attae of Appointed Tr er Date <br />FOR OFFICE UTS E ONLY <br />Date Received: 01 n <br />Employee: Delivery Method <br />❑ Nom-al Mail <br />❑ Registered Mail <br />Date Postmarked: <br />Employee: <br />[3-Mnd Delivered <br />1aC ! i' <br />❑ Electronically Filed <br />Date Scanned: <br />Employee: <br />❑ Signer has not received <br />Date Data Entered: <br />Employee: <br />mandatory training <br />Please Note: This fonncannot be used to amend con-imittee information such as the committee address, treasurer, <br />assistant treasurer, custodian <br />of books information, or account information. <br />You roust amend the Statement of Organization CR9-2100A-E to make conmrittee than es. <br />CRO-1000 NC State Board of Elect tons December 2OU I <br />