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09 <br />Amendment <br />lsciosure Report Cover CI 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 informmion- <br />1. Committee Information <br />a. Full Name <br />c. 11.) Number <br />1% Mailing Address (include City, State and Zip Code) <br />d. Date Filed <br />-3-C G.AMlAD :5 CA) <br />�,5-1 <br />e. Phone Number <br />2. Report Year <br />3. Period Start Date (ramiddl ) <br />4. Period End Date (nuddl ) <br />15. 'Treasurer )Full Name <br />0�0'.Z 6, <br />2— ?—v? I. <br />::S� 4eAA W A j ,­4c' q.s e Ji�1 <br />6.T&pe of Committee Check One <br />9. T e of Re ort <br />(check only onetype of report 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 Expenditure ❑ Joint Fundraiser <br />❑ Thirty-five day <br />Quarterly <br />❑ Pre -referendum <br />❑ Legal Expense Fund <br />❑ Pre-primary <br />First <br />❑ Final <br />❑ Pre -election <br />❑ Pre -runoff <br />Semi-annual <br />Second <br />❑ Third <br />Fourth <br />Supplemental Final <br />Annual <br />❑ Special <br />7. a of Fund (if applicable, Check one) <br />❑ Booster Fund <br />❑ Building Fund <br />Mid Year <br />Semi-annual <br />❑ Year End <br />❑ Mid Year <br />10. Special Report Name <br />Other: <br />❑ Final <br />❑ special <br />❑ Year End <br />0 Final <br />❑ Special <br />S. Number of Fundraisers this Report <br />11. Account Information <br />11. Account Information <br />Financial Institution Full Name <br />a. Financial <br />Institution Full Name <br />b. Purpose <br />c. Account Code <br />b. Purpose <br />c. Account Code <br />RIECFIVED <br />IN -PERSON <br />d. Period Begin Balance <br />d. Period Begin Balance <br />o <br />JUL 13 202E <br />CERTIFICATION <br />CABARRUS COUNTY <br />I certify that the Committee or Fund is in compliance with all applicable <br />prA9 9o?Ui 1'A4LB & 22D-22M of Chapter 163 <br />of the NC General Statutes and that no funds are commingled with prohibited or other non -disclosed funds. I further certify that this <br />report is complete, true and correct and that I have been trained by the NC State Board of Elections, <br />I3 ?: <br />Printed Name of Si ner S n t <br />of A ointed Treasurer Date <br />FOR OFFICE USE ONLY - <br />r�6 <br />�A 4 Deli very Method <br />Date Received: Employee: <br />❑ Normal Mail <br />❑ Registered Mail <br />Date Postmarked: Employee: <br />Hand Delivered <br />7 l3'a 6 <br />y�� ❑ Electronically Filed <br />Date Scanned: Employee: <br />Date Data Entered: Employee: <br />mandatory trainingived <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 must amend the Statement of Organization (CRO-210OA-E) to make committee changes. <br />CRO-1000 NC State Board of Elections August 2008 <br />