Palacios,Maria_2023-MidyearAmendment
Disclosure Report Cover I ❑ Yea ® No
Use this form for general report and committee information, must be si<,ned and submitted along with other detailed forms.
Do not use this form to update information
L
CounInIVAWWWmation "
a. Full Name
c. to Number
COMMITTEE TO ELECT MARIA PALACIOS
b. MaBing Address (include City, State and Zip Code)
d. Date Filed
3903 GARRISON CT
MONROE, NC 28110
0727/202:
e. Phone Number
704)207-5519
2. Report Year
3. Period Start Date (mm/dd/yy)
. Period
ri d End Date (mmg,
Treasurer Full Name
?0� 01.01 00,
06/30/2023
MARIA PALAC'IOS
6. Type of Committee (Check One)
9. Type
of Report (check only one Itype o ze `'
rt om one tate o )
® Candidate Campaign ❑ Parr
MunicipalState/County
Referendum
❑ PAC ❑ Referendum
❑
Organizational
❑ Organizational
❑ Organizational
Independent
El Expenditure E] Joint Fundraiser
❑
hi
Trty-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑
❑
Pre-primary
Preelection
❑ First
❑ Second
❑ Final
❑ Supplemental Final
7. Type'of Fund f(ToPNlunable, check oat)
❑ "13111sler Fund"
❑ Building Fund
❑
Pre -runoff
❑ Third
❑ Annual
Semi-annual
❑ Fourth
❑ Special
❑
Mid Year
Semi-annual
❑ Other:
❑
Year End
® Mid Year
10. Special Report Name
❑
❑
Final
special
❑ Year End
❑ Final
❑ Special
8. Number of Fundraisers this Report
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
FIRST CITIZENS BANK
b. Purpose
e. Account Code
OUNTY
c. Account Code
COMMITTEE
BOl
iMPAIGN FIN
juL 2 7 2023
d. Period Begin Balance
d. Period Begin Balance
S 548.98
$
\ /ED
V
CERTIFICATION
1 certify that Ute 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.
I further certify that this report
is complete, true and correctand that 1 have been trained
by the NC State B vd of lectin
/�n��
'A0Yint Fn�tc•
Printed Name of Signer
6ngnmure of A Anted Treasure
ZT
D7
FOR OFFICE USE ONLY
Date Received: c7� ��
Employee:
Delivery Method
❑ Normal Mail
Date Postmarked:
7
Date Scanned: LS �7 ��J
Employee:
Employee:
Registered Mail
4 Hand Delivered
Electronically Filed
❑ 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 -E to make committee changes.
CRO -1000 NC State Board of Elections August 2008
\mendmenI
Detailed Summary 0
Use this form to summarize all disclosure renortinn forms and to rntal
1. Committee Full Name and Fund if applicable)
2. T
of Re rt
Number
COMMITTEE TO ELECT MARIA PALACIOS
2023 MID YEAR
_
Start of Election Cycle: January 1, 2021
Total this
Reporting Period
Total this
Election Cycle
4) Cash on Hand at Start
BE
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) Refunds/Reimbursements To the Committee
11) Other Receipt Sources
I Is) Interest on Bank Accounts
11 b) Contributions from Not -for -Profit Organizations
1 Ic) Outside Sources of Income
1ld) Legal Expense Fund - Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1205)
(CRo-1110)
(CRO -1120)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1260)
(CRO -1150)
(CRO -1150)
(CRO -1270)
(CRO -1265)
$
$
548.98
0.00
$
$
555.37
$ 0.00 $
2,658.52
$ 0.00 $
300.00
$ 0.00 $
0.00
$ 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) TOTAL RECEIPTS (Addltras5, 6.7, 8, 9,10. Ila, llh. llc. IldandIle)
E
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 -1510)
$
0.00
$
4,771.07
$ 0.00 $
$ 0.00 $
2,050.32
0.00
$ 0.00 $
0.00
$ 0.00 $
711.77
$ 0.00 $
0.00
$ 0.00 $
0.00
$ 0.00 $
1,460.00
18)
TOTAL EXPENDITURES (ddd liras 13a. 13b, 13c. 14.15. 16 and 17)
$
0.00
$
4,222.09
19) Cash on Hand atEnd (Idd/hies4and12together, thensubtractlira18)
ADDITI F .
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 U�JIONti@4e (CRO -1610)
23) Debts and Obligations owt®PPd@AK'C4St 44WE (CRO -1620)
24) Account Transfers Within thein@i�Q023 (CRO -1720)
25) Administrative Support (CRO -1710)
26) Forgiven Loans RECEIVED (CRO -1440)
27) 48 -Hour Notice Reports Sum (CRO -2210)
28) Contributions to be Refunded (CRO -1215)
$
$
$
548.98
0.00
1,257.18
$
.54898
$ 0.00
$ 0.00
$ 0.00
$ 0.00 $
0.00
$ 0.00 $
0.00
$ 0.00 $
0.00
$ 0.00 $
0.00
CRU -1100 NC State Board of Elections August 2008
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 lull.
�-
2. ID Numlw—
COMMITTEE TO ELECT MARIA PALACIOS
3. Lender Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
It. Job ride/Profession
d. Comments
MANAGER
MARIA PALACIOS
3903 GARRISON CT
MONROE, NC 28110
(704)207-5519
e. Start Date (mm/(Wyyyy)
c. Employer's Name/Specific Field
12/28/2021
AUTO TECH
f. End Dale (mm/dd/yyyy)
g. Rate
h. Security Pledged
Loao Amoaot
j. Remaioiag Loan Balance
tOriginal
60.00
$ 60.00
it. 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 TitleJProfession
d. Comments
MANAGER
MARIA PALACIOS
3903 GARRISON CT
MONROE, NC 28110
(704)207-5519
e. Start Date (mm/dd/yyyy)
a Emptuyer's Name/Specific Field
12 28,2021
AUTO TECH
L End Date (mm/dd/yyyy)
g. Rate
It. Security Pledged
I. Original Loan Amount
J. Remaining Loan Balance
$ 150.00
$ 150.00
k. Full Name of Lending Institution
1. Loan Number
3. Lender Information ❑ Add
a. Full Name.%failing Address &Phone
(include city, state, & zip)
❑"
b..lob Title/Profession
d. Comweets
MANAGER
MARIA PALACIOS
3903 GARRISON CIUMON COUNTY
MONROE, NC 28 "MPA1GN FINANCE
(704)207-5519 JUL2 �Z3
U
ECEIVED
e. start Date (mm/dal yyyy)
r. Employer's Name/Specific Field
12/28,2021
AUTO TECH
L End Date (mm/dd/yyyy)
g. Rate
It. Security Pledged
i. Original Loan Amount
I. Remaining Loan Balance
%
$ 276.00
$ 276.00
it. Full Name of Lending Institution
I. Loan Number
4. Total only this Pae $ 486.00
5. Total of ALL CRO -1430 Pages
$ 1257.18
(This line must be online 27 aJDeluilyd Sumnavj• Page CR0./10(l/
( /((J-/ 4.H/ NC State Hoard of Elections December 2007
Outstanding Loans
.Amendment
Pg 2 of 2 [-1 No
Use this form to report any outstanding loans received during it previous reporting period and until the loan is paid in full.
' mmitteeFLllName (and,Fund ifa lkilI _ 2. ID Number
COMMITTEE TO ELECT MARIA PALACIOS
3. Lender Information ❑ Add ❑ Remove
a. Full Name, flailing Address & Phone
(include cit), state. & zip)
b. Job Title/Profession
d. Comments
MANAGER
MARIA PALACIOS
3903 GARRISON CT
MONROE, NC 28110
(704)207-5519
a Start Date (mm/dd/)ryyy)
r Employer's Name/Specific Field
0 10/2022
AUTO TECH
f. End Date (mm/ddlyyyy)
g. Rate
h. Security Pledged
i. Original Loan Amount
j. Remaining Loan Balance
a/o
$ 771.18
$ 771.18
it. Full Name of Lending Institution
1. Loan Number
3. Lender Information ❑ Add ❑ Remove
a. Full Name. Nailing Address & Phone
(include city, state, &• zip)
b. Job Title/Profession
d. Comments
e. Start Date (mm/dd/yyyy)
c. Employer's Name/Specific Field
L End Date (mm/dd/yyyy)
g. Rate
6. Security Pledged
i. Original Loan Amount
I. Remaining Loan Balance
ao
$
$
It. Full Name of Leading Institution
L Loan Number
3. Lender Information ❑ Add ❑ Remove
'
a. Full Name, flailing Address & Phone
(include city, state, & zip)
b. Job l'itle/Profession
d. Comments
UNION COUNTY F
CAMPAIGN
JUL 2 7 2023
e. Start Date (mm/dd/yyyy)
c. Employer's Name/Specific Field
f. End Date (mm/dd/yyyy)
g. Rate
ecuruy Pledgedi.
Original Loan Amount
j. Remaining Loan Balance
k. Full Name of Lending Institution
L Loan Number
4. Total only this Pae $ 771,18
5. Total of ALL CRO -1430 Pages
(Tlds fine musi Aeon line 21 of DermUed Sumnmrc Page. CR0.11110) $ 1257.18
CRO -14.30 NC State Hoard of Elections December 2007