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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 />I. Committee Information <br />a. Full Name <br />r. ID Number <br />C— � E l ec-A 1; i{ T�nl,5 <br />C lefrlto C'awr�" <br />f,qm�, <br />b. Mailing Address [include City, State and Zip Code] <br />d. Date Filed <br />38 45 Beoi 0l ,reeK1),r SwS <br />4 - dc7- d?o,,Zlo <br />co f1cc�-� t N C Zs ❑ a I <br />e. Phone Number <br />91`89C7 - 5k ! 31 f <br />2. Report Year <br />3. Period Start Date (mmlddlyy) <br />4. Period End Date <br />(mmld <br />g, Treasurer Full Dame <br />G. Type of Committee (Check One) <br />9. Type <br />of Report (check only one ty e ofreport_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 />❑ <br />Thirty-five day <br />Quarterly <br />❑ Pro -referendum <br />❑ Legal Expense Fund <br />❑ <br />❑ <br />Pre-primary <br />Pre -election <br />First <br />❑ Sceond <br />❑ Final <br />❑ Supplemental Final <br />7. of Fund (if applicable, check arx) <br />❑ "Booster Fund" <br />❑ Building Fund <br />❑ <br />Pre -runoff <br />❑ Third <br />❑ Annual <br />Semi-annual <br />❑ Fourth <br />❑ Special <br />1-1 <br />Mid Year <br />Semi-annual <br />❑ Other: <br />❑ <br />Year End <br />❑ Mid Year <br />10. Special Report Name <br />❑ <br />❑ <br />Final <br />Special <br />❑ Year End <br />E] 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 />NFa <br />b. Purpose <br />c. Account Code <br />b. Purpose <br />c. Account Code <br />_., <br />t�PERSON : <br />d. Period Begin Balance <br />d. Period Begin Balance <br />_.. FEB 2 D 2026 <br />$ <br />CERTIFICATION <br />CABAR <br />$oARD OF ELECTIONS <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 <br />further certify that this report <br />is complete, true and correct and that I have been trained <br />by the NC Stale Board of Elections. <br />l�dncl<3 [4, :RYb'- <br />-- W4N1de>_-RCQlyul't-1 <br />J - Zo-o2Dot( <br />Printed Name of Signer <br />Signature of Appointed Treasurer <br />Date <br />FOR OFFICE USE ONLY <br />Date Received: C.l1 ��� <br />Employee: - i Delivery Method <br />❑ Normal Mail <br />Date Postmarked: <br />Employee: ❑ Registered Mail <br />Hand Delivered <br />V, k/ E] <br />Electronically Filed <br />Date Scanned: <br />Employee: <br />❑ Signer has not received <br />mandatory training <br />Date Data Entered: <br />Employee: <br />Plcase Note: 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 QOA-E) to make committee changes. <br />CRO-1000 NC State Board of Elections August 2008 <br />