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Palacios,Maria_2023-FinalDisclosure Report Cover Amend yeesnt hNo Use this form for general report and committee information, must be signed and submitted alon_ with other detailed forms. Do not use this form to update information L Committee Information a. Full Name o. IU �uw Lrr COMMITTEE TO ELECT MARIA PALACIOS It. MaiBng Address (include City, State and Zip Code) d. Date Filed 3903 GARRISON CT MONROE, NC 28110 071271202' e. Phone Number (704) 207-5519 2. Report Year 3. Period Star[ Date pnm/dd/.t`y1 4. Period End Date g, Treasurer Full Name mm/ddl . 5023 07 01 'o'; 071272023 MARIA PALACIOS 6. Type of Committee Check One) 9. T e of Re rt check only one 1 D e of )'e ort from one cure gor ,1 ❑ Candidate Campaign ❑ Pan) Municipal state/County Referendum ❑ PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational Independent t Fundraiser ❑ Expenditure ❑ d ❑'' Thirty-five five da Y' Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ ❑ Pre-primary, Pre-election ❑ First ❑ Second ❑ Final ❑ Supplemental Final 7. Type of Fund (ifapplimble, check one) ❑ "BUUSICr Fund" ❑ Building Fund ❑ Pre -runoff ❑ Third ❑ Annual Semi-annual ❑ Fourth ❑ Special ❑ Mid Year Semi-annual ❑ Other: ❑ Year End ❑ Mid Year 10. Special Re port Name ❑ ❑ Final Special ❑ Year End ® Final ❑ Special 8. Number of Fundraisers this Report o 11. Account Information 11. Account Information a. Financial Institution Full Name a. Financial Institution Full Name FIRST CITIZENS BANK It. Purpoae c. Account Code b. c. Account Code COMMITTEE M Fit BOI JUL 2 7 2023 d. Period Begin Balance d. Period Begin Balance $ 548.98 s RECEIVED 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 to NC General Statutes and that no funds are commingled with prohibited or other non -disclosed funds. I furter certify that this report is complete, true and correct and that I have been trained by to NC State and o lecti s. INlow- I C" P�,lnreos 7/a7/�oa3 Printed Name of Signer L Signature of A pointed Treasurer Date FOR OFFICE USE ONLY Date Received: �� Employee: I? Delivery Method ❑ Normal Mail Date Postmarked: Employee: g Registered Mail [❑� Hand Delivered I Date Scanned: 4 Employee: Electronically Filed f�—�� ❑ Signer has not received I Date Data Entered: Employee: mandatory training Please Note: This form cannot be used to amend committee information such as to committee address, treasurer, assistant treasurer, custodian of books information, or account information. You must amend to Statement of Organization CRO-2IOOA-E) to make committee changes. CRO -1000 NC State Board of Elections August 2008 Amendment Detailed Summary ❑ Yes ® No Use this form to summarize all disclosure reoortine forms and to total monetary information_ . Committee Full Name (and Fund if applicable) 2. Type of Report 3. ID Number COMMITTEE TO ELECT MARIA PALACIOS 2023 FINAL Start of Election Cycle: January 1, 2021 Total this Reporting Period Total this Election Cycle 4) 5) 6) 7) 8) 9) 10) 11) Cash on Hand at Start Aggregated Contributions from Individuals Contributions from Individuals Contributions from Political Party Committees Contributions from Other Political Committees Loan Proceeds Refunds/Reimbursements To the Committee Other Receipt Sources Ila) Interest on Bank Accounts 1lb) Contributions from Not -for -Profit Organizations Ile) Outside Sources of Income lid) 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) $ 548.98 $ $ 0.00 $ 555.37 $ 0.00 $ 2,658.52 $ 0.00 $ 300.00 $ 265.00 $ 265.00 $ 0.00 $ 1,257.18 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 12) 13) 14) 15) 16) 17) TOTAL RECEIPTS (Addlines 5,6, 7, 8, 9, 10. Ila, ilb. 11c. lldandIle) Disbursements 13a) Operating Expenditures (CRO -1310) 13b) Contributions to Candidates/Political Committees (CRO -1310) 13c) Coordinated Party Expenditures (CRO -1310) Aggregated Non -Media Expenditures (CRO -1316) Loan Repayments (CRO -1420) Refunds/Reimbursements From the Committee (CRO -1320) In -Kind Contributions (CRO -1,510) $ 265.00 $ 5,036.07 $ 0.00 $ 2,050.32 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 711.77 $ 813.98 $ 813.98 $ 0.00 $ 0.00 $ 0.00 $ 1,460.00 18) TOTAL EXPENDITURES (Add lines 13a. 136,13e, 14. 15. l6and l7) $ 813.98 $ 5,036.07 19) Cash on Hand at End (.4aahms4and12together, thensablracthw 18) AD AL INFO' 20) Non -Monetary Gifts Given to Other Committees (CRO -1330) 21) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) 22) Debts and Obligations owed By the Committee (CRO -1610) 23) Debts and Obligations owed To the Committe (CRO -1620) NION COUNT 24) Account Transfers Within th�!#gFINANCE (CRO -1720) 25) Administrative Support ? 7 2023 (CRO -1710) 26) Forgiven Loans (CRO -1440) 27) 48 -Hour Notice Reports Sum RECEIVED (cRo-2220) 28) Contributions to be Refunded (CRO -1215) I $ 0.00 $ 0.00 $ 0.00 $ 443.20 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ $ 443.20 $ 443.20 $ 0.00 $ $ 0.00 $ CR04100 NC State Board of Elections August 2009 Contributions from Other Political Committees Pg Use this form to report contributions from other candidate, referendum or PAC committees Amendment of I ❑ Yes ® No 1. Committee Full Name and Fund if a lic.4e. 2. ID Number COMMITTEE TO ELECT MARIA PALACIOS 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Committee d. Comments ® Candidate ❑ PAC ❑ Referendum ELECT JODI MCCONKEY FOR UCPS DISTRICT 4 4107 LOGAN CIRCLE INDIAN TRAIL, NC 28079 (704) 272-3245 c. Level Registered (Specify) ❑ Federal ® Comity: ❑ State El Municipality: e. Election Sum to Date $ 265.00 f. Account Code g, Form of Payment h. In -Kind Description i. Date (mm/dd/yyyy) J. Amount 130t CHECK 07/25/2023 $ 265.00 3. Contribut ❑ Add ❑ Remo . . a. Full Name. Mailing Address & Phone (include city, state. & zip) b. Type of Committee d. Comments ❑ Candidate ❑ PAC ❑ Referendum a Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sam to Date $ f. Account Code g. Form of Payment h. In -Kind Description i. Date (mm/dd/yyyy) j. Amount $ 3. Contributor Information ❑ Add ❑ Remove H. Full Name, Mailing Address & Phone (include city. state. &zip) b. Type of Committee it. Comments ❑ Candidate ❑ PAC ❑ Referendum e. Level Registered (Specify) ❑ Federal ❑ County: ❑ Smte ❑ Municipality: e. Election Sum to Date $ E Account Code NG h. In -Kind Description i. Date (mm/dd/yyyy) J. Amount AM 023 $ JUL $ 4. Total only this Page $ 265.00 5. Total of ALL CRO -1230 Pages $ 265.00 (Thi., line mm7 be on line 8 of Demiled Smnutmry Page CRO -11001 CRO -1230 m Yate Board of Flwions April 2007 Loan Repayments Else this form to report pacIII oil ts oil an emstill" loan. Amendment Pg I or 1 ❑ Yes ® No 1. Committee Full Name d Fund if applicable) 2. ID Number COMMITTEE TO ELECT MARIA PAL.ACIOS 3. Lender Information ❑ Add ❑ Remove a. Full Name. Mailing Address & Phone (include city, state, & zip) b. Comments MARIA PALACIOS 3903 GARRISON CT MONROE, NC 28110 (704) 207-5519 c. Original Loan Date 10/10/2022 d. Original Loan Amount $ 771.18 e. Remaining Loan Balance f. Account Code g, Form of Payment h. Date{mm/ddlyyyy) 4 Repayment Amount $ 0.00 BOl CHECK 07/26/2023 $ 771.18 3. Lender Information ❑ Add [❑ Remove,., a. Ftdl Name, Mailing Address & Phone (include city, state, & zip) h. Comments MARIA PALACIOS 3903 GARRISON CT MONROE, NC 28110 (704) 207-5519 c. Original loan Date 12/28/2021 it. Original Loan Amount $ 60.00 e. Remaining Loan Balance E Account Code g, Form of Payment h. Date (maddd/yyyy) i. Repayment Amount $ 17.20 BOI CHECK 07/26/2023 $ 42.80 S $ 3. Lender Information ❑ Add ❑ RerrI a. Full Name. Mulling address & Phone (include ciy, state, & zip) It. Comments U111011N F1NF CE Op,MPP1G 1111 2 � 1023 ,VL GE1vE� e. Original Loan Date d. Original Loan Amount $ e. Remaining Loan Balance r. Account Code g, Form or Payment Is. Date (mm/ddlyyyy) 1. Repayment Amount 4 -Total only this Page , Total of ALL CRO -1420 Pages (rdLs line mrrsr 6t online 15 of Derailed Sanmmry Page CRO -110) filili $ 813.98 $ 813.98 CRO -1420 NC State Board of Flections December 2007 Outstanding Loans .Amendment Pg I of 2 ❑ Yes ® No Use this forni to report any outstanding loans reecived Burin_ a previous reporting period and until the loan is paid in full. Committee Full Name Rttd,Fumd if a '. . _ . '2. m Number COMMITTEE TO ELECT MARIA PALACIOS 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments MANAGER MARIA PALACIOS 3903 GARRISON CT MONROE, NC 28110 (704)207-5519 e. Start Date (mm/dd/yyyy) e. Employer's Name/Specific Field 12/28/2021 AUTO TECH E End Date (mm/dd(yyyy) g. Rate h. Security Pledged 1. Original Loan Amount j. Remaining Loan Balance % $ 60.00 $ 17.20 k. Full Name of Lending Institution I. Loan Number 3. Lender Information ❑ Add ❑ Remove a. Full Name. Alaiiing Address & Phone (include city, state. & zip) b. Job Title/Profession d. Comments MANAGER MARIA PALACIOS 3903 GARRISON CT MONROE, NC 28110 (704)207-5519 e. Start Date (mm/dd/yM) c. Employer's Name/Specific Field 12/28/2021 AUTO TECH E End Date (mm/dd/yyyy) g. Rate h. Security Pledged i. Original Loan Amount I. Remaining Loan Balance % $ 150.00 $ 150.00 k. Full Name of Lending Institution 1. Loan Number 3. Lender Information ❑ Add ❑ Remove a. Full Name. Mailing Address & Phone (include cin, state. & zip) b. Job I itle/Proression d. Comments MANAGER MARIA PALACIOS 3903 GARRISON CT MONROE, NC 28110 UNC (704)207-5519 uN)Opl G(1N�NGE CPMpp1GN e. Start Date (mm/dd/yyyy) c. Employer's Name/Specific Field 12/28/2021 AUTO TECH L End Date (mmlddlyyyy) g. Rate It.Sem' 1. Original Loan Amount j. Remaining Loan Balance % C— $ 276.00 $ 276.00 k. Full Name of Lending Institution I. Loan Number 4. Total only this Page 5 443.20 5. Total of ALL CRO -1430 Pages mrr Page CRI f 00). S 34320 (This line Nest Aeon line 2l of Dererne j Sumu0. CRO -14.40 NC State Board of Elections December 2007 Outstanding Loans Amendment PR 2 of 2 ❑ Its ® No Use this form to report any outstanding loans received during, a previous reporting period and until the loan is paid in full. L Committee Fu0 Name and Fund if applicable) licable 2, ltl Number COMMITTEE TO ELECT MARIA PALACIOS 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state. & rip) b. Job Tide/Profession d. Commeats MANAGER MARIA PALACIOS 3903 GARRISON CT MONROE, NC 28110 (704)207-5519 e. Start Date (mm/dd(yyyy) e. Employer's Name/Specific Field 10/10/2022 AUTO TECH E End Date (mm/dd/yyyy) 07'26/2023 g. Rate It. Security Pledged L Original Loan Amount I. Remaining Loco Balsa" $ 771.18 $ 0.00 k. Full Name of Lending Institution I. Loan Number 3. Lender Information ❑ Add ❑ Remove a. Full ,Name. )lailing Address & Phone (include city, state. & zip) b. Job Title/Profession d. Comments _ e. Start Date (mm/dd/yyyy) c. Employer's Name/Specific Field C End Date (mm/dd/yyyy) g. Rale It. Security Pledged L Original Loan Amount j. Remaining Loan Balance oa $ $ k. Full Name of lending Institution I. two Number 3. Lender Information ❑ Add ❑ a. Full Name. Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments 1014 GOGVA ^NCE CO3 Ag, p^1GN F1N 1, �7 1 2923 lu` L e. Start Date (mm/dd/y)}y) c. Employer's Name/Speciac Field E End Date (mm/dd/yyyy) g. Rate It. Security Pledged L Original Loan Amount I. Remaining Loan Balance % $ $ k. Full Name of Lending Institution I. Loan Number 4. Total only this Pae 5. Total of ALL CRO -1430 Pa - .. (THAs line nays/ be online -'1 of Duni/rd Samnauv Page CR0.1/00) $ 0.00 $ 443.20 CRO -1430 NC State Board of Elections December 2007 Forgiven Loans P - Use this form to report any loan which has been forgiven by the lender. A Forgiven loan statement (CRO -6200) must accomoanv each foreiven loan. Amendment 1. Committee Fun Ni IID Number COMMITFEI Tt) FH -CT MARIA PALACIOS 3. Lender Information ❑ Add ❑ Remove .. a. Full Name, ylailine Address & Phone (include cin, state, & rip) h. Comments MARIA PALACIOS 3903 GARRISON CT MONROE, NC 28110 (704)207-5519 c. Original Loan Date (mm/dd/yyyy) E Election Sum to Date 12,28/2021 $ d. Original Loan Amount g. Date (mm/dd/)-M) S 60.00 07/26/2023 e. Remaining Loan Balance It. Forgiven Amount S IT20 I _'0 3. Lender Information a, Full'Name. %lailing Address & Phone (include cin, state, & zip) b. Comments MARIA PALACIOS 3903 GARRISON CT MONROE, NC 28110 (704)207-5519 c. Original Loan Date (mm/dd/yy)y) E Election Sum to Date 12/28!2021 $ d. Original Loan Amount g. Date (mm/dd/yyyy) S 150.00 07/26/2023 e. Remaining Loan Balance It. Forgiven Amount S Iio.bt' S 150.00 T ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Comments MARIA PALACIOS 3903 GARRISON CT MONROE, NC 28110 (704) 207-5519 UV410N CO NFNCE GAMP#1C'N 2021 E�C 1v F R L c. Original Loan Date (mm/dd/yyyy) E Election Sum to Date 12/28 2021 $ d. Original Loan Amount g g. Date (mm/dd/),yyyl S 276.00 07!26/2023 e. Remaining Loan Balance h. Forgiven .Amount $ 276.00 S 276.00 4. Total only this Page $ 443.20 5. Total of ALL CRO -1440 Pages $ 443.20 (This line rmtst be on line 26 of Detailed Summnq• Page CRO -1100) The lender information should contain the.same information as supplied under rhe original loan proceed CRU -/440 NC State Board of Elections December 2007 aNORTH CAROLINA STATE BOARD OF ELECTIONS Forgiven Loan Statement This form is used to report a loan that has been forgiven by the lender. The lender's signature is required on this form and it must accompany the next filed report. This Statement is to be filed with the Election Board where the committee's reports are filed. Name of Lender:Maria Palacios Committee receiving Ioan:Committee to Elect Maria Palacios Date of loan: 12/28/2021 Amount of original Ioan:60.00 *Amount of loan to be forgiven: 17.20 I, , do not wish to be reimbursed for the amount of the loan indicated above" and will consider the amount loaned a contribution to the committee. I understand and confirm no other parties are responsible for pa ment of this loan. I may not forgive a loan for which there is an outstandirgimillra�to any source. CAMPAIGN FI JUL 2 7 2023 Signat re of Lend6r llu A-eiJ Signature of Committee Treasurer CRO-h_'Uv Fu{Qiren b)an Statement vo'l NORTH CAROLINA STATE BOARD OF ELECTIONS Forgiven Loan Statement This form is used to report a loan that has been forgiven by the lender. The lender's signature is required on this form and it must accompany the next filed report. This Statement is to be filed with the Election Board where the committee's reports are filed. Name of Lender:Maria Palacios Committee receiving Ioan:Committee to Elect Maria Palacios Date of loan: 12/28/2021 Amount of original loan: 150.00 'Amount of loan to be forgiven: 150.00 I. etrro. , do not wish to be reimbursed for the amount of the loan indicated above' and will consider the amount loaned a contribution to the committee. I understand and confirm no other parties are responsible for payment of this loan. I may not forgive a loan for which there is an outstanding balance owed to any source. CAMPAIGN Q JUL 2 7 2023 mrhittee Treasurer R t Ru-(,'uf) Forgiven Loan Statement v© NORTH CAROLINA mT� STATE BOARD OF ELECTIONS Forgiven Loan Statement This form is used to report a loan that has been forgiven by the lender. The lender's signature is required on this form and it must accompany the next filed report. This Statement is to be filed with the Election Board where the committee's reports are filed. Name of Lender:Maria Palacios Committee receiving Ioan:Committee to Elect Maria Palacios Date of loan: 12/28/2021 Amount of original Ioan:276.00 *Amount of loan to be for iven:276.00 I, ho-yrkcx Qa k6Lr-co-> , do not wish to be reimbursed for the amount of the loan indicated above' and will consider the amount loaned a contribution to the committee. I understand and confirm no other parties are responsible for payment of this loan may not forgive a loan for which there is an outstanding balance owed to any source. UNION COUrNA" CAMPAIGN gnature of Committee Treasurer RECEIVED CRO -6200 Forgiven Loan Statement