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Disclosure Report Cover <br />Amendment <br />E3 Yes [XI No <br />Use this form for genera] report and connnittee information, must be signed and submitted along with other detailed forms. <br />Do not. isse this form to undat.e information_ <br />1. Committee Information <br />a. Full Name <br />c. ID Number <br />COMMITTEE TO ELECT VAN SHAW <br />h. Mailing Address (include City, State and Zip Code) <br />d. Date Filed <br />616 IRISH POTATO ROAD <br />02/16/2026 <br />CONCORD, NC 28025 <br />e. Phone Number <br />2. Report Year <br />3. Period Start Date (mmlddlyy) <br />4. Period End Date (mmlddlyy) <br />5. Treasurer Full Name <br />2026 <br />01/01/20219 <br />02/14/2026 <br />VAN SHAW <br />6. Type of Committee (Check One) <br />9. Type <br />of Report (check only one type ofreport from one category) <br />® Candidate Campaign [3 Party <br />Municipal <br />State/County <br />Referendum <br />❑ Joint Fundraiser Q PAC <br />[3 <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. rype of Fund (if applicahle, check one) <br />❑ "Booster Fund" <br />❑ Building Fund <br />❑ <br />Pre -runoff <br />❑ Third <br />❑ Annual <br />❑ Presidential Election Year Candidates Fund <br />Semi-annual <br />Fourth <br />❑ Special <br />❑ NC Public Campaign Financing Fund <br />❑ <br />Mid Year <br />Simi -annual <br />❑ <br />Year End <br />❑ Mid Year <br />10. Special Report Name <br />❑ Other: <br />❑ <br />❑ <br />Final <br />Special <br />❑ Year End <br />[3 Final <br />❑ Special <br />S. 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 Name <br />F&M BANK <br />GENED <br />b. Purpose <br />c. Account Code <br />b. Purpose IN -PERSON <br />c. Account Code <br />CAMPAIGN <br />I <br />FEB 16 2026 <br />d. Period Begin Balance <br />CABARRus COUNTy <br />d. Period Begin Balance <br />$ <br />$ <br />BOARD OF ELECTIONS <br />CERTIFICATION <br />I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 2213-22M of <br />Chapter 163 of the 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, true and correct and that I have been trained by the NC State Board <br />X� 02/16/2026 <br />f <br />Printed Name of er <br />Signature of XppointeWea9kr6i Date <br />FOR OFFICEUSEONLY <br />Delivea Method <br />Date Received: L <br />Employee: <br />❑ Normal Mail <br />Date Postmarked: <br />EtTloyee: ❑ Reglste d Mail <br />[9,114and Delivered <br />� <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 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 trust amend the Statement of Organization CRO-2100A-E to make committee chap ges. <br />CRO`1000 NC State Board or Elections uccemner zuu i <br />