Holtey,Elizabeth_2023-35-day-amendDisclosure Report Cover Yes eo1E3 No
Use this form for general report and committee information, must be signed and submitted along wi ther detailed forms.
Do not use this form to update information.
1. Committee Information
. Full Name
EGr
c. ID Number
3�M�'53
. Mailing Address (Include City, State and Zip Code)
d. Date Filed
01-7cvovlc-6t
1ey aoa3
IA/GyD1//(�?(QT /v / /Vf
e. Phone Number
2. Report Year
3. Period Start Date mm/ddl )
14. Period End Date trourwdelf )
5. Treasurer Full Name
6. T e of Committee Check One
9. Type
of Report
(check only one ape of report from one category)
Candidate Campaign ❑ Party
Municipal
State/County
Referendum
PAC ❑ Referendum
❑ Organizational
❑ Organizational
❑ Organizational
❑ Independent Expenditure ❑ Joint Fundmiser
® Thirty-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑ Pre-primary
❑ First
❑ Final
Pre-election
Pre -runoff
Semi-annual
❑ Second
❑ Third
❑ Fourth
❑ Supplemental Final
❑ Annual
❑ Special
'of Fuad (if applicable. check one) -"
❑ Boo,aer Fund
❑ Building Fund
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
10. Special Report Name
❑ Oiher
❑ Final
❑ spmal
❑ Year End
❑ Final
S. Number of Fundralsers this Report
❑ SNC."]
11. Account Information
11. Account Information �.
. Financial Institution Full Name
a. Financial JnWut p FuB..Nppte
,56C;% T.4%C�l
CAMP�IC� dNtJt
b. Purpose
G Account Code
It. Purpose
c. Account Code
, A
RECEIVE
d. Period Begin Balance
• 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 funds. 1 further certify that this
report is complete, true and correct and that I have been trained by the
NC Slate Board of Elections.
r IZIT re/'4(.E /1/0L44_e x
0�0 a -
Printed Name of Si i Signature of inted Treasurer Da e
FOR OFFICE USE ONLY
Date Received: Employee:
�q
Delivery Method
❑ Normal Mai]
Date Postmarked: Employee:
Date Scanned: a 3 Employee:
Registered Mail
Hand Delivered
Electronically Filed
9Fe
Date Data Entered: Employee:
❑ Signer has not received
mandatory training
ase 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.
re
You must amend the Statement of Organization (CRO -2100A -E) to make committee changes.
CRO -1000 NC State Board of Elections August ZWs
lmendto,at
Detailed Summary p „
Use this form to summarize all ditdowre reoortine fomes and to total monetary information
1. Committee Full Name (and Fund if applicable)
2. Type of Report
13. ID Number
L U ZA�� vt�E-
3.TM yS 3
Start of Election Cycle: January 1,
Total this
Reporting Period
Total this
Election Cycle
4) Cash on Hand at Start
S
$
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
10) RefundslReimbursemenls to the Committee
11) Other Receipt Sources
Ila) Interest on Bank Accounts
l lb) Contributions from Not -For -Profit Organizations
1lc) Outside Sources of Income
l Id) Legal Expense Fund -Other Sources
Ile) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRD -1410)
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO.1270)
(CRO -1265)
$ --
$
S
$
$
$
$
$ 3 3
$
S
$
$
$
$
$
$
$
$
$
$
$
12)TOTAL RECEIPTS (Add lines 5,6,7, 8,9, 10,11 a, l l b, l l c, l l d and l I el
$o.00
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO -1310)
13b) Contributions to Candidates/Political Committees (CRO -1310)
13c) Coordinated Party Expenditures (CRO -1310)
14) Aggregated Non -Media Expenditures (CRO -1315)
15) Loan Repayments (CRO -1420)
16) Refunds(Reimbursements from the Committee (CRO -1320)
17) In -Kind Contributions (CRO-zslo)
$
3/Q O
$
$
$
$
$ o G(�'.•=`•'
$
$ `3 2
$
$
$ a QL) '
$ Unjon
$
$
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15. 16 and 17)
$ 0.00
$
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$ 0.00 777,=s
DDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees
1) Outstanding Loans (incl. ones from other campaigns)
2) Debts and Obligations owed by the Committee
3) Debts and Obligations owed to the Committee
4) Account Transfers Within the Committee
5) Administrative Support
L6) Forgiven Loans
L7 6)48 -Hour Notice Reports Sum
(CRO -1330)
(CRO -1430)
(CRO -1610)
(CRO -1620)
(CRO -1720)
(CRO -1710)
(CRO -1440)
(CRO -2220)
S
$
$
$
$
$
$
$
$
$
$
) Contributions to be Refunded
(CRO -1215)
$
$
CRO -1100 NC State Board of Elections August 2008
Reset Form
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Amendment
Loan Proceeds Pg —L of L p vec V No
Use this form to report proceeds from a loan and loan endorsers information
A loan oroceeds statement must accomoanv each loan that is from an individual
1. Conambite M Name ami Foad tf a kable)
lloL-T6
2. ID Number
- 3 -1-M 4S 3
. Lender Information 0 Add ORemove
. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title(Proression
d. Comments
Y
EUOVIT $�T�A-l/�' / 6LT
d1 f b� kUOC / (/ 1 GiAJ /� b ` N�
v/1V6ToN,NC -�P/ov
a Start Date lmm/ddtyyyy)
c Employer's NametSpeciac Field
En ae( aoa 3
HOCiU12�W6Oi
6l,4ft6-7r6, Nc_
L End Date (mtddtYyyyy)
. Rete
%Cuc-c�1$3,
h. Security Pledged
i. Account Code
. Form of Payment
s. Amount
ab? 'T?
. Full Name or Lending Instlmtlon
Int. Loan Number
Endorsers/Makers (The people who guarantee the loan.)
. Full Name. Mailing Address & Phone
(include city, state, & zip)
b. Job "ritle/Profession
loaf
c. Employer's Name/Specific Field
E 7,f �T f --
570-7 NahDVICN tON&
A160DIk6l W1 NC a8/oy
d. Percentage
c. Amount
$
. Full Name. Mailing Address & Phone
(include city. state, &zip)
b. Job TideMrohsdon
c. Employer's Name/Sped
-. ��ll s p
OCT 0 3 2023
d. Percentage
%
e. trusaunt
$ Union
• . Full Name. Mailing Address & Phone
(indude city, state, & zip)
b. Job MdNProfemion
c. Employer's NamelSpedtie Field
d. Percentage
e. Amount
. Full Name. Mailing Address & Phone
(include city, state, & zip)
b. Job TitlelProfemion
c. Employer's Name/Spedlic Field
d. Percentage
e. Amount
$
ok
5. Total of ALL CRO -1410 Pages
(This line must be on lute 9 of Dewited Summary Page CRO -.1100)
$
CRO -1410 NC State Board of Election, April 2007
Disbursements Pg oP /^/ Amendment ❑ Yes No
Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political
committees and coordinated a ex nditures
ame (an a eable)
�UZf}BC f/ oo
Z. ID Number
3TM�{S3
Fa.Futtee
e of Disbursement (Pkase use seoarate CRO -1310 forms for each type of Disbursement.)
ratio Expense' Contributions to Candidates/PolIIIC..d Commiuccs CsxrrJin:nnl Puny Ez ndiwrc,
)1311
ee Information Add Remove
Name. Mailing Address & Phone
include city, slate, & zip)
b. Coordinated Committee Name
d. Comments
loo —9Flnl s
-516W -5 a!' �E CWG,r4P . C l
ll;S
" -✓ �roNc--gv,'rw ✓I�IVC
#;;-v
ASP TX 78758
c. Level Registered (Spedb)
eml FedCounty
❑ State ❑ Municipality:
e. Elecllou Sam to Date
1
$
. Acc a ut Code g. Farm of Payment k Purpose Cade
1. Date (mmidd/yyyy)
Amotmt �kR"equIQ Remartr_s7
$ SSr7-a S/(,NS
ab aoa3
5
4. Payee Information Add L3 Remove
. Full Name, Mailing Address & Phone
(include city, state, &' zip)
'SoCIeAL
Net✓ - NAvleN,4 B�1-cN , rG
b. Coordinated Committee Name
d. Comments
P ��Osn-v
G4M14�
c Level Registered (Specify)Mas
Federal County:
❑ state ❑ Municipality:
e. Election Sam to Date
$
. Account Code
g. Form of Payment
h Purpose Code
1. Date (mmlddlyyyy)
. Amo®t
k Required Remarks
1/1
$ Soor—
Is
4. Payee Information QU Add 0 Remove
. Full Name, Mailing Address & Phone
(include city, slide, & rip)
b, Coordinaled Committee Name
d. Comments
-- _64M
6
Blt1/NESS
Ci„/eater
lS%F !L/YT , CbM
G�x/N6TN ,4
% M
c. Level Registered (Specify)
Federal County:
❑ state ❑ Municipality:
e. Election Sum to Date
$
. Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/ddtyyyy)
i. Amount
k. Required Remarks
$
S. Total only this Page
6. Total of ALL CRO -1310 Pages
!This line goes in line 13a of Detailed Summary, Page CRO -1100 if Operating Expenses)
(This line goes in line 13b of Detailed Summary Page CRO -/100 if Contrib to C'andidales/Polftical Comm)
(This line goes in line 13c of Detailed .Summary Page CRO -1100 if Coordinated Party F.x enditures)
$ O( O J
4
^ 0,
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 retwire detailed extilanation in reuired remarks field W as
(Ko-I.f10 P Stale B&uN of Elections December NMN
Disbursements
Amendment
Pit of 3 Nes ❑ No
Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political
committees and coordinated catty expenditures
'Committee Full Name (im n applicable)
)LT-6y3�M
Number
�s3
Type of Disbursement (Please use separate CRO -1310 forms for each typeto-f�Disbursementl
O rating Fs rens. Cownbuliun> to Candidates/Political Comnmt.r. y C,n,rJinaled Pani Fs •ndimre.
Payee information Add Remove
a. Full Name, Mailing Address & Phone
Includfe/city, state//&zip)
/ �t ,s
{r �c�Irr-T PK N WM
G&KIAI -rOIV 14�
/
b. Coordinated Committee Name
d. Comments
lI.•RRW-rMAL,
c. Level Registered (Specify)
Federal Cannty:
❑State ❑Municipality:
e. Election Sum to Date
. Account Code
g. Form or Payment
1h.PurposeCocle
i. Date_(mmtdd/yyyy) . Amount
k Required Remarks
2
D �Bl
a( a 2 $/ 3
I Is
4. Payee Information NJ Add Ll Remove
. Full Name. Mailing Address & Phone
(inclu'd/e city. state, & zip)
b. Coordinated Committee Name
d. Comments
/t A ,,I `W 16 . /
MLr/}i/T-F./21-r1'TA /L/`/n/
� ry �/e-,T
/i _
V IS 74 PRI � C-^�
,�{ /]
'_1fY'
c. Level Registered (Specify)
Federal County:
❑ State ❑ Municipality:
e. Election Sum to Date
.:Recount Code
g. Form of Payment
6 Purpose Code
J. Date (mmldd/yyyyl
h. Amount
1k. Required Remarks
S a3
$ l9at 6-7
,s
$
4. Payee Information Add 0 Remove
. Full None, Mailing Address & Phone
(include city, sstalt,& zip)
b. Coordinated Committee Name
d. Comments
�7*hs —
pt/0
o
N
A14,oWU4bVb7VY—Tc.
/231 b tWC-1-`^"L
/n A1VCj%si
r_rIT
Level Registered (Specify)
Federal County:
(3State 13 Municipality:
e. Election Sum to Date
$
1. Account Code
1
g. Form of Payn em
h. Purpose Code
i. Date (nuWddlyyyy)
8 ;;toa3
. Amount
$ ISD -co
k Required Remarks
P&m-lkwp4aan
5
5. Total only this Page $ o
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Derailed Summary Page CRO -1100 if Operating Expenses)
(Thu line goes in line lab of Detailed Summary Page CRO -1100 if Contrib to CandidateslPolit ical Comm)
(This line goe, in line 13c (if Detailed Summary Page CRO -1100 if Coordinated Party Expenditures)
Cj Q 3 2�
$
CO F
(On
. 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 Partv H* - Holding Public Office Expenses
1 - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* Other
* Codes require detailed explanation in required remarks field k
CRO -1-310 NC State Board of Elections December 2009
Disbursements Pg or Anrendmcnl _ ❑ Yes ❑ No
Use this form to report expenditures from the committee for operatin'Q expenses, contributions to candidate/political
conuninees and coordinated pam expenditures
1. LName (and Fand ap�hcable)
2. ID Number
Type oDisbar (Please use senamte CRO 1310 forms for each tsce of DisbarsemeN )
O roans Ectxn.a Conmbuuons to CondldatCS/PObncad Cmnmlttees C,xxdlniod Putts Expenditure,
Payee Information Add Remove
a. Full Name, Mailing Address & Phone
include city, state, & al )
b. Coordinated Committee Name
d. Canonicals
,tad-rlelvS
Gtis tet► T t
115�s-B sTrEkoe e�w b et v�
,¢tls7iN Tx 78�sa
Level tea tspeCfy,
Federal
FeCounty:
❑ State ❑ Municipality:
e,Eleclion SumtoDate
$
. Account Code 1g. Form of Payment JIL
Patinae Cade
1. Date (mmlddfyyyy) . Amount It Required Remario
j—
8� a $i of est b SIGN -S
Is
. Payee Information Add L3 Remove
. Full'same. hailing Address & Phone
(include city, state, & zip)
It. Coordinated Committee Name
d. Commentst 4reeY
pZ V°tE/�641V 0—S
/fiPco env a Y s
•"K V" SlrCkj1Yj
N1,42oN t Caf'1
c. Level Registered (specr[y,
Federal County:
❑ State ❑ Municipality:
e. Election Sum to Date
. Account Code
g. Form of Payment
JIL Purpose Code
It. Dau (nmftidfyyyy)
D. Amount IL
Required Remarks
I T
as a
$ SSr
° _
Xel 7-
9 ao a 3 Is
9/r ? 1
W04r6Y RMN?
. Payee information Lj Add Lj Remove
. Full Name, paging Address & Phone
(include city, state, & zip)
b. Coordinated Committee Name
d. Comments
�2
2EwM�V Q/=
D614T, w
1NC
�ryA/ �b�(
c Level Registered tSpe
Federal County:
❑State ❑ Municipality:
e. Election Seen to Dere
$
. Account Code
Z
g. Form of Payment
.KBIT
h. Purpose Code
i. Date mangth fyyyy)
3/ ? 3
j.Amount
S 6-;-7
it. Required Rernarks
/2f:�'vNiJ -e
y
5. Total only this Page g
6. Total of ALL CRO -1310 Pages
(This line goes in line 130 of Detailed Summary Page CRO -1100 if Operating Expenses,
(This line goes in line lab of Detailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm)
(This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures)
g V
. Purpose Codes (test 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
1 - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* Other
* Codes retruire detailed exiflanation in rewired remarks field W
CRO -1310 NC State Board of Elections December 2009
Refunds/Reimbursements From the Committee Pg of / Amendment
1 ❑Yes ❑ No
Use this form to report refunds/reimbursements, including contributions returned to the contributor.
1. Committee Fan Name (and load K applicable)2. ID Number
�L- LI ZABE a_ -m 3 -TM 4S3
3. Payee Information Add Remove
. Full Name, Mailing .Address & Phone
(include city, slate, & zip)
it. Type of Committee
h. Original Receipt Date
Candidate PAC
❑ Referendum ❑ Party
p 't ^ -23
D /� q olOo
/'rZ R T / G
/r �}� / l /1 �� p -7'
///,7 I(�/Y,tr/Tc]E. �r�`� /� !_�t,/(%I` (
{� AX14,4W /V e r791'73
1
e. Level Registered
1. Original Receipt Amount
Federal County:
❑ State Municipality:
$ aoo —
C Purpose Code
L Election Sum to Date
$
b. Job Title/Profession
le. Employer's Name/Specific Field
g. Comments
k Account Code
AP -7_N0 J1-
I L+Z?-4-,T, /NC.
IeefilAM-AW01 V
41
. Form of Payment
Im. Required Remarks
2r'FiJnm avE 7& bus ��
n. Date (mnJddlyyyy) lo. Amount
3 aoa3 1 $duo' oO
e
3. Payee Information Add Remove
. Full Name, Mailing Address & Phone
(include city, state, &zip)
d. Type of Committee
❑ Candidate 0 PAC
[3Referendum L] Party
h. Original Receipt Date
e. Level Registered
i. Original Receipt Amount
Federal 0 county:
13 state [3 Municipality:
$
L Purpose Code
J. Election Sam m Date
. Job Title/Profession
c. Employer's Name/SpecRic Field
g. Comtowts
k Account Code
. Form of Psynosent
Im. Required Remarks In. Date (ea nlddlyyyy) In. Amount
3. Payee Information ❑ Add El Remove
a. full amt. Mailing Address & Phone
iududt w,. state, & zip)
it. Type of Committee
h. Original Receipt Date
U Candidate PAC
❑ Referendum ❑ Party'
e. Level Registered
I.Or� unt
Federal County:
❑ State ❑ Municipality:
$
L Purpose Code
. Electio Sam to Date
$inion
. Job TitlelPrefession
c. Employer's NamelSpeciRe Field
1g. Comments
k Account Code
. Form of Pavent
m. Required Remarks
n. Date (mmldd/yyyy)
o. Amount
4. Total only this Page
$
5. Total of ALL CRO -13211 Pages
(This line must m on lite 16 o Detaikd Summary Pace CRO -1100)
Purpose Codes (List detailed disbursement code in (f) above)
L - Returned to Contributor M - Overpayment for Service N - Exceeded Contribution Limit
P* - Reimbursement of in -Kind Os Other
* Codes reirmire detailed a lanation in reauired remarks field W
CRO -1320 NC State Board of Elections December 2007
i
tions
-��- NU`RTH CAROLINA
-1
State Board of Elcctions K Ethics Enforcement
Loan Proceeds Statement
This Statement is used to report detailed information about a new loan and is required to accompany the
Loan Proceeds Form in the report for which the loan is initially disclosed. If the loan is from an individual,
the lender's signature is required on this form.
This Statement is to be filed with the Election Board where the committee's reports are filed.
• Name of committee to receive loan:Mgc-T�
• Person or committee to make loan:
• Date of loan to committee:
• Name of lending institution and account number (source):
• Amount of loan: 3,3007.
• Description (if in-kind loan): 5 F RVSmkA SSCrt>Li� 6/V
Mfi eck114L , p<{urv5 /fNNC�S t - ��
• Names of all parties responsible for payment of loan (guarantors):
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• Period of loan: U✓N CAMPAIGN FINANCE
• Rate of interest of loan: )e OCT 19 2023
• Security pledged for loan: -42�' R=PCI\/G I-1
I, C.C.%ZI76e—N {%[ T6acknowledge that all of the information
(Person lendtng money to committee)
provided is complete, true, and accurate. I further understand I may not forgive a loan
that has an outstandin balance to any source.
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Signa re of Lender Dat6 Signed
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Signatur of Treasurer of Committee D to Signed
CRO -6100 Loan Proceeds Statement