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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 />~�] <br />e o�m"r vi e.e jo Ete.4 Bie.t_.DRr,r.S C6 K $ Cjpw,4+ <br />b. Mailing Address (include City, State and Zip Code) <br />d. Mte Filed <br />3845- B,--rf+ CreP-X IDY Sw <br />- <br />(�_Olnc.ovl) ti�1 r� 1 <br />e. Phone Number <br />1�& 3117 <br />2. Report Year <br />3. Period Start Date (mndddlyy) <br />4. Period End Date <br />g- Treasurer Full Name <br />(mmlddl <br />-UAS <br />o 7/6 ! 2O aS <br />b. Type of Committee (Check One) <br />9. Type of Report (check only one type of re ort from one category) <br />Candidate Campaign ❑ Party <br />Municipal <br />State/County <br />Referendum <br />PAC ❑ Referendum <br />❑ Organizational <br />❑ Organizational <br />❑ Organizational <br />Independent ❑ Joint Fundraiser <br />❑ Expenditure <br />❑ "irty-five day <br />Quarterly <br />❑ Pre -referendum <br />Legal Expense Fund <br />❑ Pre-primary <br />❑ Pre -election <br />❑ First <br />❑ Second <br />❑ Final <br />❑ Supplemental Final <br />7. Type of Fund (+f applicable, check one) <br />❑ "Booster Fund" <br />❑ Building Fund <br />❑ Pre -runoff <br />❑ Third <br />❑ Annual <br />Semi-annual <br />❑ Fourth <br />❑ Special <br />�] Mid Year <br />Semi-annual <br />❑ other: <br />❑ Year End <br />❑ Mid Year <br />10, Special Report Name <br />❑ Final <br />❑ Special <br />Year End <br />Final <br />Special <br />8. Number of Fundraisers this Report <br />11. Account Information <br />11. Account Information <br />a Financial Institution Full Name <br />a. Financial Institution Full Name <br />5+61e. Eth r &mod_ <br />b. Purpose <br />r. Account Code <br />b. Pur _ RECEIVED <br />c. Account Code <br />JAN 2026 <br />d. Period Begin Balance <br />d. Period Regin Balance <br />� X PeT4+uxe ., <br />CABARRUS COUNTY <br />BOARD OF ELECTIONS <br />1 3 7t, A13 <br />J <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 of <br />the NC General Statutes and that no funds are commingled with prohibited or other non -disclosed funds. I further certify that this report <br />is complete, true and correct and that I have been trained by the NC Stgte Board of Elections. <br />Printed Name of Signer Signature of Appointed Treasurer Date <br />FOR OFFICE USE ONLY <br />-12 -24 Delivery Method <br />Date Received: Employee: <br />❑ Normal Mail <br />Date Postmarked: Employee: Registered Mail <br />Hand Delivered <br />1- ag-11 JJAW ❑ Electronically Filed <br />Date Scanned: Employee: <br />❑ Signer has not received <br />mandatory training <br />Date Data Entered: Employee: <br />Please Nate: 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-21 OOA-E) to make committee changes. <br />CRO-1000 NC State Baard of Elections August 2008 <br />