Burns,Robert_2023-Pre-election-coverAmendment
Disclosure Report Cover o Yes ® No
Use this form for general report and committee infonration, must be signed and submitted along with other detailed fours.
Do not use this formto update information.
1. Committee Information
a. Full Name
c. 11) Number
COMMITTEE TO ELECT ROBERT BURNS
b. \lailing Address (include City, State and Zip Code)
d. Date Filed
4211 SECREST SHORTCUT ROAD
10/31/2023
MONROE, NC 28110
e. Phone Number
(704)622-7063
2. Re Year 13.
Period Start Date (mm/dd/yy)
14. Period End Date (mm/ddyy)
15. Treasurer Poli Name
2023
09127/2023
10/23/2023
ROBERT BURNS
6.Ty pe of Committee Check One
9. Type
of Re rt (check only one type o re ort m one tate a y
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ Joint Fmedraiscr ❑ PAC
❑
Organizational
❑ Organizational
❑ Organizational
❑ Referendum ❑ Legal ti spense Fund
❑
❑
m
Thirty-five day
Pre-primary
Pre-election
Quarterly
❑ First
❑ Second
❑ Pre -referendum
❑ Final
❑ Supplemental Final
7. Thn of Fund (/applicable. check one)
❑ "Monster Fund"
❑ BuildingFund
❑
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
❑ Final
❑ Special
8. Number of Fundraisers this Report
0
3. Account Information
3. Account information
a. Financial Institution Full Name
a. Financial Inatitutiom Full Name
FIRST CITIZEN BANK
b. Purpose
c.Amount Code
b. Parpos
c. Amount Code
FOR CAMPAIGN
RELATED ACTIVITY
Qv
it. Period Begin Balance
d. Period Begin Balance
l �
5
873.66
$
CERTIFICATION
1 certify that the Committee or Fund is in compliance with a8 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
fu/ads. I further certify that this report is complete,
tete trect and that I h en trained by the NC State Board
(�r%.,t_r4 ��✓rM
10/31/2023
Printed Name of Signer
gnatae of Appointed Treasurer Date
FOR OFFICE 1 S EONLY
Delivery Method
Date Received:
Employee:
❑ Normal Mail
❑ Registered Mail
Date Postmarked:
Ertployee:
❑ Hand Delivered
❑ Electronically Filed
Date Scanned:
Employee:
❑ Signer has not received
Date Data Entered:
Employee:
mandatory training
Please Note: This form cannot be used to amend committee information such as 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.
CRQ1000 NC Sate Board of Electrons December 2007