Amburgey,Michael_2025-Pre-ElectionAmendment
□ Yes □ NoDisclosure Report Cover ^
Use this form for general report and committee information, must be signed and submitted along with other detailed forms.
Do not use this form to update information.
1. 'Gomnutteellnfo^^
a. Full Name
/ f
A C#Q#A onr1 7in'C*Afl^^ «
c. ID Number.
I.-Mailing Address (include City, State and Zip Code)•. rf-d. Date Filed.
/d) 9- Coi^ U ^fc/9-7(9-0'^^
erPhoneNuniber .
2. Report Year 3. Period Start'Date (inm/dd/^)4; Period End Date (mm/dd/Vv)5; Tr^iirer Fiill Name
O't / 9.^/d.co-5 (of 9^1
6/Tvn<rr»f ComihitteefGheckiOrieY P.-Tvne of Report (check only one typKof jepoft frqin one category). '
rCTCandidateCampaign (_] Party
n PAC □ Referendum
n Independent Expenditure Q Joint Fundraiser
n Legal Expense Fund
Municipal 'State/County ■ ■-Referendum
1 1 Organizational
n Thirty-five day
n Pre-primary
^>3-Pre-election
n Pre-runofT
Semi-annual
n Mid Year
n Year End
[~l Hnal
1 1 Special
1 1 Organizational
Quarterly
n First
n Second
n Third
n Fourth
Semi-annual
1 1 Mid Year
n Year End
[~l Final
Q Special
1 1 Organizational
n Pre-referendum
n Final
n Supplemental Rnal
Annual
n Special
10. Special Report Naine .
7. Type of Fund Of applicable, check one)
n Booster Fund
n Building Fund
n Other
L Number of Fimdraisers this Report
11. Account iMormaiionr ^ ; • . - > ^ .—i. • - — • ,
a PSn«nn!alTnct5tiit!nnFiillName " . a. Flnanciallnstitution Full Name .. 1 .
tr
bi Purpose'c. Account Code.b.' Purpose
d. Period Begin Balance -
$ 5'7z7/
c. Account Co'de ra^
d. Period Begin Balsmce.
$
CERTIFICATION
certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 22D-22M of (Chapter 163f .u.» Mr« ctaHitoc ttnA thnt nn fiind^ are comminsled with nrohibited or other non-disclosed funds. I further certify that thisof the NC General Statutes and that no funds are commingled with prohibited'report is complete, Uiie and correct and that I have been^3HTea"ByTh# NC^taie Board of Elections.
]fy[TcUAL.i (i
Printed Name of Signer ^Signwure of Appointed T Date
FOR OFFICE USE ONLYlo/nfeDate Received:
Date Postmarked:'
Date Scanned:
Date Data Entered:"
I?
Delivery Method
)□ Normal Mail
Sn Registered Mail
Hand DeliverediQ Electronically Filed
Employee:
Employee:
Employee:
Employee:
Please Note: This fonflGilmdt 5e2G2B to amend committee information such as the committee address, treasurer,assistant treasurer, custodian of books information, or account information.
You must MeutW iSmMt of Organization (CRO-2100A-E) to make committee chauges.
RECEIVED O Signer has not receivedmandatory trainini
CRO'lOOO NC State Board of Elections
DetaUed Summary
Amendment
Q"^"□ No
7/)^.pre.-o
Total this
Reporting Perinri
^nn'4
Total this
Election Cvcle
jStart of Elecaon Cycle: January 1, Slo %>■
4) Cash on Hand at Start 1 $ 1$ II 5) Aggregated Contributioiis from Individuals " -----
6) Contributions from Individuals
7) Contributions from Political Party Committees
8) Contributions from Other Political CommittPPc"
9) Loan Proceeds
(CRO-1205)
(CRO-I2IO)
(CRO-J220)
(CRO.I230)
(
$
5 /96//33
CRO.I410)
'(CRO:i2'40j111) Other Receipt Sources
Ha) Interest on Bank Accounts
lib) Contributions from Not-For-Profit Or^iiizationTTcmyls^J
He) Outside Sources of Income
(CRO-1250}
(CROHd) Legal Expense Fund - Other Sources
He) Exempt Purchase Price Sales
'l250)
(CRO.1270)
iCRO-1210)jjb) Contributions to Candidates/Political Committees' (CRO-mo)
13c) Coordinated Party Expenditures
[l4) Aggregated Non-Media Expenditures
Il5) Loan Repayments
(CRO-J3IO)
iCRO-1315)
(CRO16) Refunds/Reimbursements from the Committee
j
-1420)
l7) In-Kind ContributionsI
(CRO-J320)
(CRO-ISIO)18) TOIAI. J.AfKNDITURES (Add lines 13a. 13b, 13c. 14. 15.19) Cash o„ Hang at Knd (Add lines 4 and 12 .oge.her, then subtrac. $ TT j
1.1..[yon-Monetary Gifts Given to
ht^i.9A
5?,'>
jlO) Non-Monetary Gifts Given toj21) Outstanding Loans (incl. ones from other campaigns) (CRO-1430)
22) Debts and Obligations owed by the ComiiiiteT (CRO-uio)
j23) Debts and Obligations owed to the Committee
24) Account Transfers Within tiie Committee
pS) Administrative SuppofjECEIVhD
|26) Forgiven Loans „ ,
— —
(CRO-162Q)
(CRO-mO)
(CRO-17JO)
(CRO.1440)
(CRO-mS)
NC State Board of Elections
2 August 2008
Aggregated Contributions from Individuals Page of
Optional form used to report NC Contributions From Individuals of $50 or less'
Amendment
n Yes □ No
l.Gommittee Full Name (and Fund if applicable) '2. ID Number
3. Contributor Information
a..Amend b. Account Code c. Form of Payment d. In-Kind Description e. Date (mm/dd/yyyy) .f. Amount□ Add
n Remove Oolo i-f'
U Add
n Remove ^ivirw*vArti HocKi /o/aj/aoa-s-$ 9.
LI Add
f~l Remove $
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1~I Remove $
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LI Add
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Li Add
n Remove s
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n Remove $
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n Remove $
Q Add
n Remove $
LI Add
n Remove $
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n Remove $
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n Remove s
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n Remove
KECEr /ED
$
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^ Remove nr.T 2 7 ZUZb $
□ Add
n Remove
UNION CC
BOARD OF E
)UNTY
.ECTIONS s
□ Add
Remove $ ■;!
□ Add
3 Remove $
4. Total only this Page J 3c.. i?"?5. Total of ALL CRO-1205 Pages
(This line must be on line S of Detailed Summary Page CRO-1160)« 3 6.SI
Contributions from Individuals
Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used
Pg of
Amendment
□ Yes □ No
1. Committee Full Name (and Fund if applicable)2. ID Number
3. Contributor Information [[J] Add il_I Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession d. Comments'
"fl-vowu^s
/£>/X F*^<-c. Employer's Name/Specific Field
e. Election Sum to Date
□
□
□plye-ri
□ A
lofiej3035"
/o/as/,
<503.'?^
3. Contributor Information dd P Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
Cc>i/^ii^ri FtVe. ^tV^C£.
^*4ciufVJ f N-ZC ol
f. Prior
□
□
g. Account Code h. Form of Payment
b. Job Title/Profession
c. Employer's Name/Specific Field
i. In-Kind Descnption
d. Comments
e. Election Sum to Date
j. Date (mm/dd/yyyy)
/o/»3/ao'3L5"
/o/33ja«s>.5
k. Amount
3. Contributor Information P Add ' P Remove
a. Full Name, Mailing Address & Phone
(include city, state,,& zip)
f. Prior
□
g. Account Code h. Form ofPa\
b. Job Title/Profession
c. Employer's Name/Specific Field
escription
OCT 202^
d. Comments
e. Election Sum to Date
j. Date (mm/dd/yyyy)k. Amount
-UtU
□board c!
1 COUNTY
F ELECTIONS
4. Total only this Page ^37.M
5, Total of ALL CRO-1210 Pages
(This line must be on line 6 of Detailed Summary Page CRO-IlOO)V37, (I
CRO-1210 NC Slate Board of Elections April 2007
In-Kind Contributions pg of
Amendment
□ Yes □ No
Use this form to report non-monetary contributions, donations, goods or services provided to the committee or fund.
1. Committee Full Name (and Flind if applicable)2. ID Number
3. Contributor Information ^ U |LJ Add |LJ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
(o/^ Cot^e^n f'lf Lu\ct<.
^KIC. 9L§07't
b. Type of Contributor
u Individual^^Candidate
rn Party
□ PAG
□ Referendum
□ Other Receipt Source
c. Comments
d. Election Sum to Date
e. Description f. Date (mm/dd/yyyy)g. Fair Market Amount
/o/lfijd.O'X-S
3. Contributor Information O Add O Remove
a. Full Name, Mailing Ad.dress & Phone
(include city, state, & zip)'
S
b. Type of Contributor
tJ Individual^.Candidate
□ PAC
□ Referendum
□ Other Receipt Source
c. Comments
d. Election Sum to Date
e. Description f. Date (mm/dd/yyyy)g. Fair Market Amount
3 $ 130.0-5-
3. Contributor Information ;□ Add - o Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Type of. Contributor
ET Individual
Candidate
n Party
□ PAC
□ Referendum
□ Other Receipt Source
c. Comments
d. Election Sum to Date
e. Description f. Date (mm/dd/yyyy)g. Fair Market Amount
■) 1 2025
4. Total only this Page BOARP OFtLb^'$ I/O'O I s gL
5. Total of ALL CRO-1510 Pages
(This line miisf be on line 17 of Detailed Summary Page CRO'J100)^00 .S «3—
CRO-1510 NC Slate Board of Elections December 2007