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Disclosure Report Cover <br />Amendment <br />❑Y'es ®No <br />Use this form for general report and committee information. must be signed and submitted along with other detailed torrns. <br />F)n nn1 ncf- Ihic form in irndgfP infnrmatinn <br />I. Committee Information <br />a. Full Name <br />C. III Numhi•r <br />COMMITTEE TO ELECT VAN SHAW <br />b. Mailing Address (include City, State and Zip Code) <br />tl. [late l ilcd <br />616 IRISH POTATO ROAD <br />07/06/2026 <br />CONCORD, NC 28025 <br />e. Phone Number <br />2. Re rt Year <br />3. Period Start Date (m mlddlyy) <br />02/15/2026 <br />4. Period End Date l m m iddi" I <br />06/30/2026 <br />5. Treasurer Full Name <br />VAN SHAW <br />2026 <br />6. Type of Committee (Check One) <br />9. T <br />of Re rt (cheek only one ry e o re or! •om one tale orti j <br />® Candidate Campaign ❑ Part% <br />Municipal <br />state/County <br />Referendum <br />❑ <br />Organizational <br />[] Organizational <br />❑ Organizational <br />Joint Fundraiser ❑ PAC <br />❑ Referendum Legal Expense Fund <br />C1 <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. Dr of Fund (if applicable, check one) <br />"Booster Fund" <br />❑ Building Fund <br />❑ <br />Pre -runoff <br />C1 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 />Setni-annual <br />❑ <br />Year End <br />❑ Mid Year <br />10. Special Report Name <br />0 Other: <br />[] <br />❑ <br />Final <br />special <br />Year End <br />❑ Final <br />8. Number of Fundraisers this Re rt <br />0 <br />Special <br />3. Account Information <br />3. Account Information <br />a. Financial Institution Full Name <br />a. Financial 111\tl[uti0IL Full Nance <br />F&M BANK <br />b. Purpose <br />c. Account Code <br />b. Purpose IN -PERSON <br />c. Account Code <br />CAMPAIGN <br />l <br />P y. JULJ 102� <br />CABARRUS COUN`fY <br />d. Period Begin Balance <br />d• Period Begin Ralanee <br />g <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 & 22D-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 />8a�- G,� <br />Printed Name of Signer <br />-�- R� 07/06/2026 <br />-gnature of Appointed Treasur Date <br />FOR OFFICEIDSEONLY <br />Date Recei►•ed: 0 1 V b Ud <br />Employee: Delivery Method <br />❑ Normal Mail <br />Date Postmarked: <br />— / - � <br />Date Scanned: <br />Employee: ❑ Registered Mail <br />( nd Delivered <br />Employee: �a � El Electronically Filed <br />Date Data Entered: <br />Employee: ❑ Signer has not received <br />mandatory training <br />Please Note: This form cannot be used to amend comrnittce information such as the committee address, treasurer. <br />ass istatit treasurer, custodian <br />of books information. or account information. <br />You must amend the Statement of Or aniration CRO-21o0A-F, to make committee than es. <br />CRO-1000 NC.' Ntate t3oaro of ttections Uecemoer 14VU r <br />