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Burroughs,Weston_2022-4th-qtr-reportDisclosure Report Cover ;Amendment Y s IM No Use this form for general report and committee information, rust be signed and submitted along with other detailed forms. Do not use this form to update information. 1. Committee Information a. Full Name c. Ill Number COMMITTEE TO ELECT WESTON BURROUGHS XXX-CJMD90-X-XXX b. Mailing Address (include City, State and Zip Code) d. Date Filed 6720 OLD MONROE RD 01/11/2023 STE B 146 e. Phone Number INDIAN TRAIL, NC 28079 (980) 494-0780 2.ReportYear 3. Period Start Date (mm/dd/yy) 4. Period End Date (mm/dd/yy) 5. Treasurer Full Name 2022 10/23/2022 12/31/2022 CRISTAL ROBINSON 6. of Committee (Check One) 9.Type of Report check only one loype o re ori •om one cate o ® Candidate Campaign ❑ Party Municipal State/County Referendum ❑ Joint Fundraiser ❑ PAC ❑ Organizational ❑ Organizational ❑ Organizational ❑ Referendum Legal Expense Fund ❑ ❑ Thirty-five day Pre-primary Quarterly ❑ First ❑ Pre -referendum ❑ Final 7. Type of Fund (if applicable, check one) ❑ "Booster Fund" ❑ Pre-election ❑ Second ❑ Supplemental Final ❑ Building Fund ❑ Pre -runoff ❑ Third ❑ Annual ❑ Presidential Election Year Candidates Fund Semi-annual ® Fourth ❑ Special ❑ NC Public Campaign Financing Fund ❑ Mid Year Semi-annual ❑ Year End ❑ Mid Year 10. Special Report Name_ ❑ Other: ❑ ❑ Final Special ❑ Year End [M Final ❑ special 8. Number of Fundraisers this Re rt Q 3. Account Information 3. Account Information a. Financial Institution Full Name a. Financial Institution Full Name FIRST CITIZENS BANK b. Purpose e- Account Code b. Purpose c. Account Code CAMPAIGN 100 d. Period Begin Balance d. Period Begin Balance $ $ CERTIFICATION I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 22D -22M of Chapter 163 of the NC General Statutes and that no funds are commingled with prohibited or other non -disclosed funndss., I further certify t}�at this report is complete, true and correct,a Td� hat 1 -have been trained by the NC State Board L \�\S� �(`� � �h5,1` =te d 01/11/2023 Printed Name of Signer Signature of A *ointed Treasurer Date FOR OFFICE USE ONLY ( Delivery Method Date Received: Employee: ❑ Normal Mail ❑ Registered Mail Date Postmarked: Employee: bI and Delivered Date Scanned: .•. [3Electronically Filed �V E I V Date Data Entered: ' En�loyA�N 11 2023 ❑ Signer has not received mandatory training Please Note: This form cannot be used to amend co n te90n Wf PAgbF" the committee address, treasurer, assistant treasurer, custodian of books information, or account information. You must amend the Statement of Organization CRO -2100A- to make committee changes. CRO -1000 NC State Board of Elections December 2007 Detailed Summary Amendment ❑ Yes ®No Use this form to summarize all disclosure renortine forms and to total monetary information 1. Committee Full Name and Fund if a icable 2. T)M of Report 13. ID Number COMMITTEE TO ELECT WESTON BURROUGHS 2022 Fourth Quarter XXX-CJMD90-X-XXX Start of Election Cycle: January 1, 2021 Total this Reporting Period Total this Flection Cycle 4) Cash on Hand at Start $ 172.96 $ 0.00 RECEIPTS 5) Aggregated Contributions from Individuals 6) Contributions from Individuals 7) Contributions from Political Party Committees 8) Contributions from Other Political Committees 9) Loan Proceeds 0) Refunds/Reimbursements to the Committee 1) Other Receipt Sources I la) Interest on Bank Accounts 11 b) Contributions from Not -For -Profit Organizations 11 c) Outside Sources of Income I Id) Legal Expense Fund- Other Sources 11 e) Exempt Purchase Price Sales (CRO -1205) (CRO -1210) (CRO -1220) (CRO -1230) (CRO -1410) (CRO -1240) (CRO -1250) (CRO -1250) (CRO -1250) (CRO -1270) (CRO -1265) $ $ $ $ $ $ $ $ $ $ $ 8.00 190.00 200.00 0.00 0.00 175.62 :' 0.00 0.00 0.00 0.00 0.00 $ 1,628.00 $ 6,397.72 $ 300.00 $ 0.00 $ 1,355.59 $ 3,698.70 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 2) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9,10,11a,11b,IIc,1ld and lle) $ 573.62 $ 13,380.01 EXPENDITURES 3) Disbursements 13a) Operating Expenditures 13b) Contributions to Candidates/Political Committees 13c) Coordinated Party Expenditures 4) Aggregated Non -Media Expenditures 5) Loan Repayments 6) Refunds/Reimbursements from the Committee 7) In -Kind Contributions (CRO -1310) (CRO -1310) (CRO -1310) (CRO -1315) (CRO -1420) (CRO -1320) (CRO -1510) $ $ $ $ $ $ $ 313.30 0.00 0.00 141.56 291.72 0.00 0.00 $ $ $ $ $ $ $ 11,149.58 0.00 0.00 1,110.40 291.72 0.00 828.31 8) TOTAL EXPENDfITJRES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ 746.58 $ 13,380.01 9) Cas It on Hand at End (Add lines 4 and 12 together, then subtract line 18) $ 0.00 $ 0.00 ADDITIONAL INFORMATION 0) Non -Monetary Gifts Given to Other Committees (CRO -1330) 1) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) 2) Debts and Obligations owed by the Committee (CRO -1610) 3) Debts and Obligations owed to the Committe (@!x{620) 4) Account Transfers Within the Com �r (0?0-1720) 5) Administrative Support ��+N 1 0 Ro-1710) 6) Forgiven Loans E4�`O�c44o) Won Go guard afi (CRO -2220 48 -Hour Notice Reports Sum ( ) $ 0.00 $ ,fir t 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 1,063.87 $ 1,063.87 $ 0.00 $ 0.00 �7) 8) Contributions to be Refunded (CRO -1215) $ 0.00 $ 0.00 CRO -1100 Nu atate tsoare or tiections rlugUSL wvo Amendment Aggregated Contributions from Individuals Page 1 of 1 ❑ Yes ® No Optional form used to report NC Contributions From Individuals of $50 or less 1. Committee Full Name and Fund if a icable 2. ID Number COMMITTEE TO ELECT WESTON BURROUGHS XXX-CJMD90-X-XXX 3. Contributor Information a. Amend b. Account Code c. Form of Payment d. In-IGnd Description e. Date (mm/dd/yyyy) f. Amount Add ❑ Remove 100 Debit Card 11/16/2022 $ 5.00 Add ❑ Remove 100 Debit Card 10/25/2022 $ 3.00 4. Total only this Page $ $8.00 5. Total of ALL CRO -1205 Pages (This line must be online S of Detailed Summary Page CRO -1100) $ $8.00 CRO -1205 NC State Board of Elections April 2007 R1 JAN 1 i 2a� Union Co. Board of Elections Contributions from Individuals Amendment Pg I of 3 ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Fall Name and Fund if a icable 2. ID Number COMMITTEE TO ELECT WESTON BURROUGHS XXX-CJMD90-X-XXX 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments NOT EMPLOYED _ _ _ JIM BURROUGHS 916 White Oak Dr WARNE, NC 28909 c. Employer's Name/Specific Field NOT EMPLOYED e. Flection Sum to Date $ 90.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 100 Debit Card 11/16/2022 $ 10.00 ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments ONLINE TUTOR ERIN EWART 1513 CALDER DRIVE INDIAN TRAIL, NC 28079 c. Employer's Name/Specific Field BOOKNOOK e. Flection Sum to Date $ 105.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 100 Debit Card 11/17/2022 $ 10.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job'Htle/Profession d. Comments NOT EMPLOYED DANIEL HANNUM 4116 Hoffineister Dr WAXHAW, NC 28173 c. Employer's Name/Specific Field NOT EMPLOYED e. Rection Sum to Date $ 80.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 100 Debit Card 11/06/2022 $ 10.00 ❑ $ R JE C_'E I V L_ -JL s 4. Total only this Page, '." $ 30.00 5. Total of ALL CRO -1210 Pages (This line must be online 6 of Detailed Summary Page CRO -1100) Lnjnn CC. BOaR G '._^ ` $ 190.00 CRO -1210 NU :state Board of htections April Lou i Contributions from Individuals Amendment Pg 2 of 3 ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Full Name and Fund if a licable 2. ID Number COMMITTEE TO ELECT WESTON BURROUGHS XXX-CJMD90-X-XXX 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments NOT EMPLOYED STEPHANIE KARAFFA 1907 Crestgate Drive WAXHAW, NC 28173 c. Employer's Name/Specific Field NOT EMPLOYED e. Election Sum to Date $ 200.00 f. Prior g. Account Code h. Form of Payment ji. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 100 Debit Card 11/16/2022 $ 25.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments NOT EMPLOYED ELIZABETH PROSSER 1269 BURLEYSON LANE WAXHAW, NC 28173 c. Employer's Name/Specific Field NOT EMPLOYED e. Election Sum to Date $ 100.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 100 Credit Card 10/25/2022 $ 100.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Flull Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments PHYSICIAN KATIE SHAW _ 9824 Saddle Ave I l E FEZi V WAXHAW, NC 28173 JAN 11 2023 c. Employer's Name/Specific Field VALLEY EMERGENCY le. Flection Sum to Date $ 335.00 f. Prior g. Account Code h. Form of aymen CTd-lfta Description j. Date (mm/dd/yyyy) k. Amount ❑ 100 Debit Card 11/17/2022 $ 25.00 ❑ $ 4. Total only this Page i $ 150.00 5. Total of ALL CRO -1210 Pages (This line must be online 6 of Detailed Summary Page CRO -1100) $ 190.00 CRO -1210 NC State Board of Elections April 2007 Contributions from Individuals Amendment Pg 3 of 3 ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Full Name and Fund if a licable 2. ID Number COMMITTEE TO ELECT WESTON BURROUGHS XXX-CJMD90-X-XXX 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job 15tle/Profession d. Comments OFFICE MANAGER _ JULIE WESLAKE 513 Pine Needle Ct MATTHEWS, NC 28104 c. Employer's Name/Specific Field TerraSource Valuation LLC e. Flection Sum to Date $ 65.00 f. Prior g. Account Code h. Form of Payment i. In -Fund Description j. Date (mm/dd/yyyy) k. Amount 13100 Debit Card 11/16/2022 $ 10.00 ❑ $ ❑ 1 $ 4. Total only this Page $ 10.00 5. Total of ALL CRO -1210 Pages (This line must be online 6 of Detailed Summary Page CRO -1100) $ 190.00 CRO -1210 NC State Board of Elections .Apra 200 t RECEIVE® JAN 11 2023 Union Co. Board of Elections Amendment Contributions from Political Party Committees Pg I of I []Yes ® No Use this form to report contributions from a political party 1. Committee Full Name and Fund if a 'cable) 2. ID Number COMMITTEE TO ELECT WESTON BURROUGHS XXX-CJMD90-X-XXX 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) UNION COUNTY DEMOCRATIC WOMEN 7905 TOTTENHAM WAXHAW, NC 28173 b. Comments c. Election Sum to Date $ 200.00 d. Account Code e. Form of Payment E fn-IGnd Description g. Date (mm/dd/yyyy) It. Amount 100 Check 11/03/2022 $ 200.00 $ 4. Total only this Page $ 200.00 5. Total of ALL CRO -1220 Pages (This line must be online 7 of Detailed Summary Page CRO -1100) ; $ 200.00 CRO -1220 NC State Board of Elections April 2007 RECEIVE® JAN 11 202J Union Co. Board of Elections Amendment Refunds/Reimbursements To the Committee Pg 1 of 1 ❑ Yes ® No Use this form to report refunds received by the cormnittee or reimbursements for a previous expenditure. 1. Committee Full Name and Fund if a icable 2. ID Number COMMITTEE TO ELECT WESTON BURROUGHS XXX-CJMD90-X-XXX 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) d. Type of Committee g. Comments Candidate Ej PAC ❑ Referendum ❑ Party META PLATFORMS, INC 1601 WILLOW ROAD MENLO PARK, CA 94025-1452 e. Level Registered (Specify) h. Original Expenditure Date Federal 0 County: ❑ State [3 Municipality: 12/12/2022 i. Original Expenditure Amt $ 75.00 b. Job Titie /Profession c. Employer's Name/Specific Field f. Purpose j. Election Sum to Date ERROR $ 278.30 k. Account Code 1. Form of Payment m. In -Kind Description in. Date (mm/dd/yyyy) o. Amount 100 Draft 12/19/2022 $ 75.00 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) d. Type of Committee g. Comments Candidate E3 PAC ❑ Referendum ❑ Party META PLATFORMS, INC 1601 WILLOW ROAD MENLO PARK, CA 94025-1452 e. Level Registered (Specify) h. Original Fxpenditure Date 0Federal 0 County: 13 State [3 Municipality: 12/13/2022 i. Original Ekpenditure Amt $ 75.00 b. Job Title[Profession c. Einployer's Name/Specific Field f. Purpose j. Election Sum to Date ERROR $ 278.30 k. Account Code 1. Form of Payment m. In -Kind Description n. Date (mm/dd/yyyy) o. Amount 100 Draft 12/19/2022 $ 75.00 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) d. Type of Committee g. Comments Candidate PAC ❑ Referendum ❑ Party TARGET 6350 Weddington WESLEY CHAPEL, NC 28104 REC e. Level Registered (Specify) h. Original Fxpenditure Date Federal County: ❑ State ❑ Municip;Ii. 10/21/2022 IE Original Expenditure Amt $ 29.77 b. Job Title /Profession 1c. Employer's Name/Specificagpj Ir j. Election Sum to Date Uniop CQ- NOT NEEDED Ird Qf ElaCtion.c $ 137.67 k. Account Code 1. Form of Payment Tm. In -Kind Description n. Date (mm/dd/yyyy) o. Amount 100 Electric Funds Tran 10/24/2022 $ 25.62 4. Total only this Page $ 175.62 5. Total of ALL CRO -1240 Pages$ (This line mus! be on line 10 of Detailed Summary Page CRO -1100) 175.62 CRO -1240 NC State Board of Elections December 200 Disbursements Amendment Pg 1 of 1 ❑ Yes ® No Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political committees and coordinated party expenditures 1. Committee Full Name LaSd Fund if a icable 12. ID Number COMMITTEE TO ELECT WESTON BURROUGHS - - - 3. Type of Disbursement (Please use separate CRO -1310 forms for each type ofDisbursement.) IR Operating Expenses Contributions to Candidates/Political Committees Coordinated Party Expenditures 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments META PLATFORMS, INC 1601 WILLOW ROAD MENLO PARK, CA 94025-1452 c. Level Registered (Specify) Federal County: ❑ State ❑ Municipality: e. flection Sum to Date $ 278.30 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks 100 Debit Card A 10/25/2022 $ 13.64 FACEBOOK PAGE 100 Debit Card A 11/03/2022 $ 35.00 FACEBOOK ADS 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments META PLATFORMS, INC 1601 WILLOW ROAD MENLO PARK, CA 94025-1452 c. Level Registered (Specify) Federal County: ❑ State ❑ Municipality: e. Election Sum to Date $ 278.30 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks 100 Debit Card A 11/07/2022 $ 50.00 FACEBOOK AD 100 Debit Card A 11/25/2022 $ 64.66 ADVERTISING 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip-) b. Coordinated Committee Name d. Comments META PLATFORMS INC 1601 WILLOW ROAD 1 E ��. f 4 _,w MENLO PARK, CA 94025-1452 q rrl ;n,i I�- LI� ��' it ; • Level Registered (Specify) -- — - - Federal County: ❑ State ❑ Municipality: e. Election Sum to Date $ 278.30 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks 100 Debit Card A 12/12/2022 $ 75.00 FACEBOOK ADS 100 Debit Card A 12/13/2022 $ 75.00 FACEBOOK ADS 5. Total only this Page $ 313.30 6. Total of ALL CRO -1310 Pages (This line goes in line 13a ofDetailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 13b ofDetailed Summary Page CRO -1100 ifContib to Candidates/Political Comm) (This line goes in line 13c ofDetailed Summary Page CRO -1100 if Coordinated Party Expenditures) j $ 313.30 7. Purpose Codes (List detailed expenditure code in (h.) above) A* - Media B* - Printing C* - Fundraising D -To Another Candidate E - Salaries F* -Equipment G - Political Party H* - Holding Public Office Expenses I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* Other * Codes require detailed a anation in required remarks field (k) CRO -1310 NC State Board of Elections December 2009 Amendment Aggregated Non -Media Expenditures Page 1 of 1 ❑ Yes El No Optional form used to report NC Non -Media Expenditures of $50 or less. 1. Committee Full Name (and Fund if applicable) 2. ID Number XXX-CJMD90-X-XXX COMMITTEE TO ELECT WESTON BURROUGHS 3. Payee Information a. Amend b. Account Code c. Form of Payment d. Purpose Code e. Date (mm/dd/yyyy) f. Amount g. Required Remarks Add 100 Debit Card K 11/07/2022 $ 3.82 BANK FEE ❑ Remove Add 100 Draft K 12/05/2022 $ 1.44 BANK FEE ❑ Remove Add 100 Draft K 12/09/2022 $ 4.37 BANK FEE ❑ Remove Add 100 Debit Card 0FOOD 10/31/2022 $ 9'78 FOR 13 Remove VOLUNTEERS Add 100 Debit Card B 11/07/2022 $ 10.00 CAMPAIGN TSHIRTS ❑ Remove Add too Debit Card O 10/24/2022 $ 26.86 FOOD & DRINK FOR 13Remove VOLUNTEERS Add 100 1 Debit Card O 10/27/2022 $ 10.43 FOOD FOR ❑ Remove VOLUNTEERS Add 100 Debit Card O 10/24/2022 $ 10.68 EVENT SUPPLIES ❑ Remove Er Add 100 Debit Card 0 11/07/2022 $ 6.41 TSHIRT ❑ Remove ET Add 100 Debit Card 0 11/09/2022$ 8.66 ELECTION DAY ❑ Remove PARTY Add too Debit Card 0 11/10/2022 $ 49.11 I ELECTION DAY I 0 Remove PARTY 4. Total only this Page $ 141.56 5. Total of ALL CRO -1315 Pages $ 141.56 (This line must be on line 14 of Detailed Summary Page CRO -1100) 6. Purpose Codes List detailed expenditme code in d above B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses I - Postage J - Penalties K* - Office Expenses Q* - Donations to Legal Expense Fund O* - Other * Codes require detailed explanation in required remarks field CRO -1315 NC State Board of tiecttons iicccuiuci u RECEIVED JAN 11 2023 Union Co. Board of Election Amendment Loan Repayments Pg 1 of I ❑ Yes ® No Use this form to report payments on an eiasting loan. 1. Committee Full Name and Fund if a icable 2. ID Number COMMITTEE TO ELECT WESTON BURROUGHS XXX-CJMD90-X-XXX 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Comments WESTON BURROUGHS 6720 OLD MONROE RD STE B 146 INDIAN TRAIL, NC 28079 (980) 494-0780 c. Original Loan Date 12/23/2021 d. Original Loan Amount $ 200.00 e. Remaining Loan Balance f. Account Code g. Form of Payment h. Date (mm/dd/yyyy) i. Repayment Amount $ 66.62 100 Check 12/19/2022 $ 133.38 $ $ 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Comments WESTON BURROUGHS ^ 6720 OLD MONROE RD STE B 146 INDIAN TRAIL, NC 28079 (980) 494-0780 c. Original Loan Date 01/10/2022 d. Original Loan Amount $ 1,050.00 e. Remaining Loan Balance f. Account Code g. Form of Payment h. Date (mm/dd/yyyy) i. Repayment Amount $ 891.66 100 Check 12/20/2022 $ 158.34 4. Total only this Page $ 291.72 5. Total of ALL CRO -1420 Pages (This line must be on line 15 ofDetailed Summary Page CRO -1100) $ 291.72 CRO -1420 NC State Board of Elections December 2007 RE ChV1Lu ,lam IN ► 1 1)023 Union co.. B02rc of Elections Outstanding Loans Amendment Pg 1 of 2 ❑ Yes ® No Use this form to report any outstanding loans received during a previous reporting period and until the loan is paid in full. 1. Committee Full Name and Fund if a icable 2. ID Number COMMITTEE TO ELECT WESTON BURROUGHS XXX-CJMD90-X-XXX 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments TRAINING & OPERATIONAL EXCELLENCE MANAGE WESTON BURROUGHS 6720 OLD MONROE RD STE B 146 INDIAN TRAIL, NC 28079 (980) 494-0780 e. Start Date (mm/dd/yyyy) c. Employer's Name/Specific Field 12/23/2021 MEINEKE CAR CARE f. End Date (mm/dd/yyyy) g. Rate h. Security Pledged i. Original Loan Amount j. Remaining Loan Balance N/A $ 5.99 $ 5.99 k. Full Name of Lending Institution 1. Loan Number 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments TRAINING & OPERATIONAL EXCELLENCE MANAGE WESTON BURROUGHS 6720 OLD MONROE RD STE B 146 INDIAN TRAIL, NC 28079 (980) 494-0780 e. Start Date (mm/dd/yyyy) c. Employer's Name/Specific Field 12/23/2021 MEINEKE CAR CARE f. End Date (mm/dd/yyyy) g. Rate h. Security Pledged i. Original Loan Amount j. Remaining Loan Balance $ 99.60 $ 99.60 k. Full Name of Lending Institution 1. Loan Number 3 Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments TRAINING & OPERATIONAL EXCELLENCE MANAGE _ WESTON BURROUGHS 6720 OLD MONROE RD STE B 146 INDIAN TRAIL, NC 28079 (980) 494-0780 e. Start Date (mm/dd/yyyy) c. Employer's Name/Specific Field 12/23/2021 MEINEKE CAR CARE f. End Date (mm/dd/yyyy) g. Rate h. Security Pledged i. Original Loan Amount j. Remaining Loan Balance N/Afr fry gg 200.00 "I E .- L d $ 52.75 k. Full Name of Lending Institution 1. Loan Number 4. Total only this Page Union Co. Board of Elections, 158.34 5. Total of ALL CRO -1430 Pages (This line mast be on line 21 ofDetailed Summary Page CRO -1100) $ 0.00 CRO -1430 NU state Board of tlections UUcull,ml Outstanding Loans Amendment Pg 2 of 2 ❑ Yes ® No Use this form to report any outstanding loans received during a previous reporting period and until the loan is paid in full. 1. Committee Full Name and Fund if a icable 2. ID Number COMMITTEE TO ELECT WESTON BURROUGHS XXX-CJMD90-X-XXX 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments TRAINING & OPERATIONAL EXCELLENCE MANAGE WESTON BURROUGHS 6720 OLD MONROE RD STE B 146 INDIAN TRAIL, NC 28079 (980) 494-0780 e. Start Date (mm/dd/yyyy) c. Employer's Name/Specific Feld 01/10/2022 MEINEKE CAR CARE f. Fad Date (mm/dd/yyyy) g. Rate h. Security Pledged i. Original Loan Amount j. Remaining Loan Balance $ 1,050.00 $ (158.34) k. Full Name of Lending Institution L Loan Number 4. Total only this Page $ (158.34) 5. Total of ALL C110-1430 Pages (This line must be on line 21 of Detailed Summary Page CRO -1700) $ 0.00 CRO -1430 NC State Board of Elections J 1 1 23,23 Union co, Boar r December 2007 Amendment Forgiven Loans Pg 1 of 1 ❑ yes ® No Use this form to report any loan which has been forgiven by the lender. A Forgiven loan statement (CRO -6200) must accorwanv each forgiven loan. 1. Committee Full Name and Fund if a icable 2. ID Number COMMITTEE TO ELECT WESTON BURROUGHS XXX-CJMD90-X-XXX 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Comments WESTON BURROUGHS 6720 OLD MONROE RD STE B 146 INDIAN TRAIL, NC 28079 (980) 494-0780 c. Original Loan Date (mm/dd/yyyy) L Election Sum to Date 01/10/2022 $ 0.00 d. Original Loan Amount g. Date (mm/dd/yyyy) $ 1,050.00 12/30/2022 e. Remaining Loan Balance h. Forgiven Amount $ (158.34) $ 1,050.00 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Comments WESTON BURROUGHS 6720 OLD MONROE RD STE B 146 INDIAN TRAIL, NC 28079 (980) 494-0780 c. Original Loan Date (mm/dd/yyyy) f. Election Sam to Date 12/23/2021 $ 0.00 d. Original Loan Amount g. Date (mmJdd/yyyy) $ 200.00 12/31/2022 e. Remaining Loan Balance h. Forgiven Amount $ 52.75 $ 13.87 4. Total only this Page $ 1,063.87 5. Total of ALL CRO -1440 Pages (This line must be on line 26 of Detailed Summary Page CRO -1100) $ 1,063.87 The lender information should contain the same information as supplied on the original loan proceed statement CRO -1440 NC Mate Board of Elections ucccmocr Lw FIV JAN 1 2023 Union Co. Board of Elections