Martin,Angel_2025-Finalw* f'AnicndinisntDisclosure Report Cover |[] yes
Use &is form for gene^ report and committee mformatiotu must be signed and submitted along with o&er de
DojgUis^^i^fora^^igdat^mfonn^on.
Np„
forms.
a.FuilNa
fh^ Miw^~b> ^
b. Mafling Addre^ ^dude Gity,' State and Zip Code)%0\ i4 UuM\JUlAAnjc,cL (M .
}j^^\l'{ri jOO 2^)73
c.IDN[imber
iDC>J'Ml1VM
d. Date FU^
UlhIzS'
e. Phone Niunber
2;]Rep6rt:Y^r 3.:Penod Stellate (in^^ 4,'PeriQd End j)ate (mmA^yy)^ 5.^^rr^a!^er';'Repdrt'Y^r 3.tPeriod Start Da
nmS'auJL n
6/Type'ofC^iiiniltfee:(Gheck"One)-
ifiwrrfifiafff P-ampaign |~" ) Party
□ PAC □ Referendum
lod^eiideatExpaiditure Joint Fundrai^
O Legal Expense Rmd
□ BoosterRmd
□ BuSding Rmd
n Other
S^Nijmbcrdffiihdi^^'itfaK
"27
9i ~l^e of RejidrtH (cJwclCpnly djietype, qfireportjrdm pne-cdtegdry); j v!
Mnnidpal
I I Organizadonal
□ Hitity-five day
□ Pre-piimary
□ PiB-electioii
n Prc-mnoff
Semi-armoal
n Mid Year
Year End
Rnal
Special
Stote/Coimty ■ ^
□ Organizational
Quart»iy
n First
ri Second
n Ihird
ri Fourth
Senu-annaal
□ Mid Year
O Year End
n Hnal
special
Referendom
□ Organizational
□ Pt^iefeicndomn Final
□ Supplemental Final
□ Annual
n special
lOi-Spedal Report Name.
ll^"rAcd)imtlhfoniiatidn'^t''f2 llvArtoiihtIhfoiTOatidhv<i^rM27!ir':?77
a. Finandal Ristftiition Foil Name a. Plnahcial Tnstifnfinh Foil Naihe^UjKisrf
b. Purpose c. Account Code tLPnrppse c. Aazmnt Code
d. Period B^nBalandi d. P^od Be^ Balance
$ /a35.^o $
CERUFIGATION 3 .
I certify that the Comimttee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 22D-22M of Chapter 163
of the NO General Statutes and that no funds are commingled with^pfQ^bited or other non-disclosed funds. 1 further certify that this
NCiState Board ofHectioiis.report is con^lete, true and correct and that I have been trained by the
Name of Signer Signature of Appointed Treasurer
IFOR OFFICEI^ ONLY
bate Rreeiv^ „
Date Postinadc^ _
Date Scanned: _
Date Data Entered: ■ _
En^loyee:
Employee:
Enqiloyee:
En^iloyee:
iA Delivery Method
□ Normal MailD Registered Mail
□ Hand Delivered -n Electronically Filed
n Signer not received.
mandatory training .
Please Note: This form cannot be used to amend committee information such as die committee address, treasurer,
treasurer, custodian of books infonnatioo, or account infoimadon.
Tou man amend the Statement of Organization (CRO-2100A-E) to make committee changes.
cRo-1000 ■ |02||gb
uH«ft@aMWY ■
NC State Board ofElections
Reset, Fbrrii^'
August 2008
Detailed Summary Amendment□ Yes ^No
1. Cominittee Full Name (and Fund if applicable)2. Type of Report 3. ID Number.
TW- tomi ht. h
Start of Election Cvcle: .Tannarrl.Total this
Reporting Period
Total this
Election Cvde
4) Cash on Hand at Start $
RECEIPTS
5) Aggregated Contributions from Individuals (CRO'1205)$ / 0. oo $
6) Contributions from hndividuals (CRO-1210)$ U?60.00 $
7) Contributions from Political Par^ Committees (CRO-U20)$$
8) Contributions from Other Political Committees (CRO-I230)$$
9) Loan Proceeds (CRO-14IO)$$
10) Refunds/Reimbursements to the Committee (CRO-1240)$ 1 /C)0,cO $
11) Other Receipt Sources ■■■■■■
11a) Riterest on Bank Accounts (CRO-12SO)$$
lib) Contributions from Not-For-Profit Organizations fCJ!O-i250>$$
11c) Outside Sources of Inrome (CRO-12SO)$$
Ud) Legal Expense Fund - Other Sources (CRO-mO)$$
lie) Exempt Purchase Price Sales (CRO-1265)$$
12) TOTAL RECElFfS (Add lines 5,6.7,8,9,10,1 la,lIb,llc,lld and 1 le)$0 n/'D,£)0 $
EXPENDITURES
13) .Disbursements
•7? •• "N.13a) Operating Expenditures (CRO-1310)$$
13by Cohtributions to Candidates/Political Committees iCRO-1310)$$ ■*
13c) Coordinated Party Expenditures iCRO-mO)$$
14) Aggregated Non-Media Expenditures (CR0-131S)$$
15) Loan Repayments (CRO-1420)$ 1^36.$
16) Refunds/Reimbursements from the Committee (CRO-I320)$$
17) In-Kind Contributions (CRO-ISIO)$$
18) TOTAL EXPENDITURES (Add lines 13a. 13b, 13c, 14,15,16 and 17)$0 $
19) Cash on Hand at End (Add lines 4 and 12 together, then sobtiact line 18^$
ADDITIONAL ESFGRMATION
20) Non-Monetary Gifts Given to Other Committees (CRO-JSSO)$
21) Outstanding Loans (ind. ones from other campaigns)(CRO-1430)$■■■■■I
22) Debts and Obligations owed by the Committee (CRO-16IO)$
23) Debts and Obligations owed to the Committee (CRO-I620)$
24) Account Transfers Within the Committee (CRO'J720)$
25) AdminidrsiHvR Support (CRO-niO)s $26) Forgiven Loans RECOVoir'{CRO'1440)$$
27) 48-Hour Notice Reports Sum rlJK V-iV /f 9?^(CRO-2220)$$
28) Contributions to be Refunded (CRO-I215)$$
ACRO'llOO BOARD 01- ELE
toaid of Elections
Reset Form
ugust 2008
Aggregated Contributioiis from Individuals page
Optional form used to report NC Contributions From fiidividuals of $50 or less
Amendment . .
H.No
1. Comniittee Full Name (and Fund if applicable)2. ID Number
1D ATUi^VM
3. Contributor biformation ^
a. Amend b. Account Code n d' Form of Payment d. In^Kind Description dDate (mm^dd/yyyy)f.Ainount'
ig. Add
Remove Ckiek.10 3 |2ir $ /O.OO
Q Add
D Remove $
Q Add
O Remove $
Q Add
Itemove $
o Add
n Rmnove $
□ Add
n RoDove $
Q Add
Remove $
Q Add
Q Remove $
Q Add
n Ronove $
Q Add
n Remove $
!□ Add
Q Remove $
Q Add
Remove $
□ Add
D Remove $
□ Add
Q Remove $
Q Add
n Remove $
Q Add
Ronove $
□ Add
n Remove $
□ Add
n Remove rtW WplV/f^$
o Add
Remove
RE $
Q Add
n Rranove UK C H) i»$
Q Add
n Remove .
UNIDMCOUNlV*
$
□ Add
^3 Remove $
Q Add
1 1 Remove $
4. Total only tilis Page $ lo.oo
5. Total of ALL CROt1205 Pag^
(IKslmemustbeonlmeSofDelailedSammaiyPageCRO'IlOO) ... .$ It), uo
CRO-ms NC State Board of Elections April 2007
Contributions firom individuals
Use Ais form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not us^
PB
/ Amendment1 of ID Yes ^0 No
1. CopunitteeJ^ Name (and Fund if applicable)2. ID Number
' 1 ro^ UbjMk\T\€C h MOaAm.fD 33/^1 HI//1
3. Contributor LiformatiDn ^ Add LJ Remove
a. FtinNam^ Mailing Addr^ & nidne
Gndnde city, stale, & zip)
b. Job Tide/Profession d. Comments
Aadh iiccAr
1 \j\^ ^1-
Ucuchou) .vCZ'ii 73
e. Employer's Name/Specific Field
/xch e. Election Sam to Date
$ 100. oO
F. Prior g. Acomnt Code h. Fonn of Payment 1. In-BSnd Description j. Date (mndddlyyyy)k. Amount
□lo/z-l /zs"$ )Oft. oo
□$
□$
3. Contributor Infonnation 0 Add LJ Remove
a. Foil Nam^ Mailing Addreffl & Plidne
Onrinde dtf, state, & rip)
b. Job Tide/Profession d. .Comments
nurs^Sm itU ,
760) yly\
c. Employer's Name/SpcdJic Field
e. Election Sam to Date
$ /OO.BO
r. Prior g. A^nnt Code h. Fonii of Payment L In-Kind Description j. Date (mm/dd^yyy)k. Amoont
□1 o/;?'//z^$ joo.oo
□$
□$
3. Contributor biformation LJ Add □ Remove
a. FuH Name, MaiUng Address & Plione
(inclode state, & rip)
b. Job Ude/Pnfession d. Comments
Luc-)l'o &)ui^.lOdj^dui^ lUUiTVlAiLDKn, pC ^
c. Employer's Nanie/Spedfic Fidd
c. Election Sum to Date
$ 1200.00
r. Prior g.AccoDnt Code h. Form of Payment i. In-Bnd Description j. Date (nunfddy^yyy)k. Amoiml
□lolz'^/2,5'$200.00
□$
□FiEQhWEu
\$
4. Total only this Page ^ 0'ifi' f
5. Total of ALL CRO-1210 Pages mW
(This tine must be on line 6 of Detailed Safnfnni7 Page CRO'il(^Qj\QD S &OO.OO
CRO-mo NC State Board of Elections April 2007
1. Coininittee Full Name (and 1 if applicable)2. ID Number
T^e fhikiL\ 'kc -
3. Contributor hifonnation J yy Add LI Remove
d
Contributions from Individuals
Use diis form to report individual contribudons over $50 or contribudons under $50 if form CRO 1205 is not usef
Pg
Amendment
□ Yes i^No
(indade stati^ & zip)
OD ^-foheKtcfg-/- Ly\
--€(D
c. Employer's NanK/SpedllcIpedllc
. Comments
e. Election Snm to Date
$ ^00. oo
[, Mpr g. Account Code h. Form ofPayment L Ih-Kind Description . j. Date (mhi/dd/yyyy) k. AmoonlV-OO.OO□ZdUc^(0 $
□
3. Contribotor Lifonnation □ Add □ Remove
a. Fnll Name, MaHing Addres & 14ione
(indnde dly, state, & dp)
b. Job Title/Profession
c. Employer's NamdSpectfic Field
d» Comments
e! Election Sum to Date
$
r.-Mor g. Account Code h. Form of Payment Lin-Kind Descriptidn j. Date (mm/dd/yyyy) k. Amonnt
$
□
3. Contributor InformatiDn □ Add □ Remove
a. Full Name, Mailing Address & Rione
(inHnHc- d^, state, & zip)
b. JobHtle/Profession
c. Employer's Nanie/Spedfic Field
d. Comments
e. Election Sum to Date
$
LPrior g. Account Code h.FonnofI^ynient Lla-CndDesdiption j. Date (nnn/dd/yyyy) k. Amount
□$
□
□I®iCG.:1o200l5
4. Total only this Page $ 3~0o.co
5, Total of ALL CRO-1210 Pages
(Has Bae mnsi be on line 6 of Detailed Summary Page CRO-2IM)
CRO'1210 NC State Board of Elections April2007
Refunds/Reimbursements To the Committee pg j[.
Use this form to report refunds received by flie committee or reimbursements for a previous expenditure.
of
Amendment
□ Yes 1S No
1. Committee Full Name (and Fund If applicable) .2. ID Number
feAAAJii+0"^ ^ mj&m 1 H \I}A
3. Contributor Infonnation Add LJ Remove
a. Full Name, Mailii^ Address & Phone
. (indu^ dfy, state, & zip)
d. Type of Committee g. Comments
Candidate 1 1 PAC^3 Referendum ^3 PartyCfb^ph
MaK\lin\ /CC 22115
e. Level Re^stered (Specify)h. Original Expenditure Date
LI Federal Ll County:Q State Municipally
L Original Expenditure Amt
$ 6DO.D-0
b. Job Title/Profession e. Employe's Name/Specific Fidd (.Purpose ^j. Election Sum to'Datie
1
kcufX)(}xyY\puifYi c{jin(>Awe\$
k. Account Code L Fonn of Paj^meot m. ]b-Kind Descrqrtlon n. Date (mmfdd^yyy)0. Amount
-ZMc^$52)0.^^
3. Contributor Information (2^ Add [_] Remove
a. Fun Nam^ Mailing Address & Phone '
(indude dty, state, & zip)
d. Type of Committee g. Commentss['Candidate Q PAC
n Referendum ^3 PartyCToseploOio ^ Anpcmh)S>t
e. Level Registered (Specify)tu Original Fxppnilitni^ Date
LI Federal U. County:
O State [2jI Municipality:
L Original Expmditnre Amt
^/i'OD-OO
b. Job IlUe/Professioa c. Employer's Name/Specific Field LPurpose j. Election Sum to Date
$ / f OD. 00
k. Acconnt Code 1. Form of Paymoit m. Di-Kind Description n. Date (mm/dd/yyyy)6. Amount11/7/25'
3. Contribntor Information ,LJ Add O Remove
3. Foil Name, Mailing Addres & Phone
dndode d^, state, & zip)
d. Type of CoDunittee g. Comments
LJ Candidate 1 1 PAC
C3 Referendum ^3 Party
e. Level Roistered (Spedly)h. Original Expenditure Date
LI Federal jj County:
O State [n Monicipality:
L Original Expenditure Amt
$
b. Job Tide/Profession c. Enqiloyer's Name/Spedllc fidd Purpose j. El^on Sum to Date
$
k. Account Code L Form of Payn^t m. Tn.Ktnd Description n. Date (mm/ddtyyyy)0. Aim) ant
D $
4. Total only this Page nRP^in s UOo.oo5. Total of ALL CRO-1240 Pages U§ii ^VJ
(This tine must be on line 10 ofDetaiUd Summary Page CRO-1160) \s llOO.OO
Disbursements
Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political
Pg
Ameodment
□ Yes
1. Ccmmittee FUU Name and Fund if applicable) .2. ID Number
0(L/(J)WJLl m ^Kn 1
3. Type of Disbursement (Please use seoarate CRO-13iO forms for each tvoe ofDisbursement)
Operating Expenses LJ Contributions to Candidates/Political Committees LJ Coordinated Paitv Expenditures
4. Payee Information ;□ Add ;□ Remove
a. Full Name, Mailing Address & Phone
^clndc dty, state, & zip)
b: Coordinated Committee Name d. Comments
c. Level Registered (Specify)
1 1 Federal 1 J County:
n State "^B^Muriidnalitv:
Chc^, 1 1 ■mclircdmw
e. Election Sum to Date
i3il£MvA)'5 VlZ^&
/67Z)
$
f. Amimt Code g. Fonn of fayniCTt
tMcLd''
b. Purpose Code i. Date (mm/dd/yyyy)j. Amoont k. Required Reniaris
PaA::+l
4. Payee Infonnation ;□ Add ;□ Remove
a. Full Name^ Mafling Addre^ & Pbone
tinclude dty, state, & dp)
b. Cooniinated Committee Name d^ Comments
(jhi^c Level Roistered (Specify)LJ ftderal LJ Conner:CD State ^3 Municipality:e. Election Sum to Date
$
I. Account Code g. Form of Pajjnent II Purpose Code i. Date (mm/dd/yyyy)j. Amount k. ReqniredRemarlss
ilTUlf pp~\n-h^
4. Pay^ Infonnation '□ Add - O Remove
^ Full Nam^ Mailii^ Address & Pbone
(indude dty, stat^ & zip)
b. Coordinated Committee Name d. Comments
{j^dbslshCc. l^vel Register^ (Spedfy)
LJ Federal Coon^n State Municipality:e. Election Suin to Date
$
f. A<xount Code g. Fonn of Payment tePurpowCode L Date (mm/dd/yyyy)j. Amoont k. Required Remarks
Oaj'AjJt'
5. Total only this Page
6. Total of ALL CRO-1310 Pages
(This Une goes in line 13a of Detailed Summary Page CRO-1100 ifOperating Expenses)
(This line goes in line 13b of Detailed Summary Page CRO'llOO if Contrib to Candidaies/PoUtical Comm)
(This line goes in line 13c of Detailed SummaryPege^^fhJJ^^X^ordinated Party Expenditures)
7. Purpose Codes (List detailed mTh.) above)
IWJI
A* - Media B* - Printme . oftoofil;" Fundraising
E - Party
n;n.r®'
D - To Another Candidate
- Holding Public Office Expenses
Q* - Donation to Legal Expense Fund
CRO-i5^ION COUNTY
BOARD OF ELECTIONS
NC Stale Board of Elections December 2009
^ ori_Amendment
□ Yes J□ NoDisbursements Pg
Use tliis form to report expenditures from the committee for operating expenses, contribution^ to candidate/politicalcoramittees^n^oordinate^^rt^Mgenditmes1» .Commit^ Full Name (and Furid if applicable)2. ID Number
3. T^e of Disburseinent (Plegse_use_sessr^e_^RO^l310foTmsJbr^ch type ofDisbursement)
Si Opera*^"E Expenses TT CoDtributions to Candidates/Political Committees Coordinated Party Expenditures
4. Payee Ii^ormatioii Add {□ Remove
a. Full Name, Mailing Address & Phone
(include dty, state, & zip)
b. Coordinated Committee Name d. Comments
S^n/fQ Ckr^c. Lieyel Roistered (Spet^y)
LI Federal LI County;□ State 0 Municipality:c. Election Sum to Date
$5,'?o
r. Account Code g. Form of Paymrat h. Purpose Code L Date (min/dd/yyyy)j. Amount k. Required Remarks
i6iz-3 2r $ 5.^0 Sfrvice clrQ/r^
t A $y
4. Payee Information 12^ Add ,□ Remove
a. Full Name, Mailing Addi^ & Fbooe
^dude d^, state, & zip)
b. Cooidiliated Cnrnmitit^d. Comments
Ma I 1 • ,r-/n
c. L^el Register^ (Spedfy)
LJ Federal |_J County:□ State ^ Municipality:e. Election Sum to Date
« 19.57
r.AKpnnt Code'g. Fpnn ofPayment b. Purpose Code L Date (nun/d^yyyy)j. Amount k, Required Remarks
Cr<z\xf lo/z,/2^
a-cctfcf-^mf2<$ 'f.77 Vuilr\^ U>
4. Payee Information ' □ Add □ Remove
a. Full Name, Mailing Address & Phone
(indude dfy, state, & zip)' -
b. Coordinated Conimitlce Name d.O)mments
c. Registered (Spedfy)
LJ Federal LJ County:□ State ^ Municipality:e. Election Sum to Date
$
F. Account Code g. Fonn of I^yment b. Purpose Code i. Date (moi/dd/yyyy)j. Amount k. Required Remarks
cfnocttf IO/iS/2S'$^^'57
$
5. Total only this Page
6. Total of ALL CRO-1310 Pages
(This line goes in Unt 13a of Debated Snmmary Page CRO-1100 ifOpemting Expenses)
(This line goes in tine 13b of Debated Summary Page CRO-1100 ifContrib to Candidates/PolMcalComm)
(^^n^oe^nUn^3^fDa^^^ummm^ag^^^n0^fCom^aie^mty^^en£^ns^^^^
7. Purpose Codes (List detailed expenditure code in (h.) above)
A* - Media
E - Salaries
I - Postage
O* Other
B* - Printi
F* - Equip
J - Penalties[JfiC, 10
Fundraising
- Political Party
* - Office Ebq>enses
D - To Another Candidate
H'*' - Holding Public Office Exq)enses
Q* - Donation to L^al Expense Fund
^Cod^^egmr^etoil^^^lMationhnjneguir^^rema^^fid^I^
CRO-1310 toaid of Eiections December 2009
Disbursements pg 3 Amecdment
□ Yes No
Use this fonn to report expenditures from the committee for operating expenses, contributions to candidate/political
1. Committee Full Name (and Fund if applicable) .2. ID NumberilM CbMrfe -fo AAAeP/Uoi^it^ID^hVM
3. Type of Disbursement (Please useseuarate CROHSIO forms.for each tvoe ofDisbursement)
iKi Ooeratiag Expenses LJ Cootributioiis to Candidales/Pplitical Committees 1 1 Coordinated Party Expeaditmes
^1. Payee Information Add □ Remove
^ Full Name, Mailing Address & Phone '
(include dty, state, & zip)
b. Coordinated Committee Name d. Comments
j\AAdtGmi'sViAhhi- ,
/A^ueJL'tn,
c. Level Registered (Specify)
1 1 Federal County:
Q State Municipality:e. Election Sum to Date
$
f. Account Code g. Form of Payment
CAldjc'
h. Purpose Code L Date (mmAld/yyyy)j. Amount k. Required Remarks
$lUM t 6ifi£&h10zltad$ ^1-1,1
4. Payee Information □ Removea. Full Name, Mailing Address & Phone /
Ondude dty, state, & zip)
b. Coordinate Committee Name d, Comments
c. Level Regi^red (Spedty)
) H Federal |_ County:n State ^3 Municipality;
I■kUmtin
e. Election Sum to Date
D o((at
$
f. Account Code g. Form of Payment h. Purpose Code L Date (mm/d^^yy) j. Amount k. R^uir^ Ronarks
4. Payee Information □ Add □ Remove
a. Full Name, MalllDg Address & Phone
(indnde dty, state, & zip)
b. Coordinated fyimmitipp Name d. ComnKnts
hAW\n, A^C
c. I^vcl Register^ (Specify)
k 1 Federal 1 1 County:
n State hd Municipality:e. Election Sum to Date
$
f. Account Code g. Form of Paymrat h. Purpose Code i. Date (nun/dd/yyyy)'misr j. Amount k. Required Remarks
VdaJriGjiuichCMAA:t
5. Total only this Page
6. Total of ALL CRO-1310 Pages
(TTiis line goes in line 13a of Detailed Summary Page CRO-IJOO ifOperating Expenses)
(This line goes in line 13h of Detailed Summary Page CRO-IIOO if Contrib to Candidates/Polidedi Comm)
(This line goes in line I3c of Detailed Summary Page CRO-IIOO if Coordinated Party Expenditures)
7. Purpose Codes (Listdet^ode in (h.) above)
Media
E - Salaries
I - Postage
O* Other
F* - Equipment
J -
C* - Fimdiuising
G - Political Party
- Ofllce Expenses
D - To Anoflier Candidate
H* - Holding Public OiBce Expenses
Q* - Donation to Legal Expense Fund
^Codesreguir^etailedw^J^^^^
CRO-1310
-y-imari^iel^l^
State Board of Electioos December 2009
Disbursements Pg
Use this form to report expeoditnres from the committee for operating expenses, contributions
T of __!□Amendment
Yes t^No
o candidate^olitical
l..GonimitteeFnU.Name.(^d.Fimd;if;applicable):'i 24in^NumberMilv:^'TKc Cjbm i io flfD^IP3JM0Mj '^rype,ofDisbureMnetit:'r;rPfedse i«lsei7flj^,GRI>^75jd/ojfTOs:/bre&A'/vD^ r ^Ijj Operating Expenses LJ Contributions to Candidates/Political Cominittees 1 1 rnnrdinatPH Party ExpMiditures
a. Full Name, Mailing AddrKS , &Phone
(include dty, state, & dp)
k Coordinated Conunittee Name d. Comments
j^mhysiWAf'(jlMeh/KVul16ul ScJt
fUC 2?) 73
c. l^d Register (Specify)
Lj Federal Li County:
Q State [m MumdpallQr;e. Election Siim to Date '
^ Full Name^ Mailing Address & Phone
(indude dty, stat^ & zip)
h.' Coordinated Committee Name d. Comments
c. LevelRegi^r^ (Specify)U Federal |_J County:
Q State Q Municipality:e. Election Sam to Dale
$
f.Accotmt Code g. Fonn ofPaymedt b. Purpose Code ;LDate (mm/dd^yyyy)j.Ainonnt k. Required Remarks
— — -- —- ■ - - • . ■ ■ I ■ .... - -., r ^ • - • • - • ' '' ^'-ba. FUI Name, MaiUogAddr^&Phone
(tnclude dty, state, & zip)
r. Account Code -g. Fqrmof Pqiiient h. Pntpoi^ Code
. Coordinated Conunittee Na
c. Level Registered (Spcdfy)
n Federal i ^ Cnnnt]^
Q State □ Mimicipabty:
L Date (mm/dd^yyyy)j.Amonnt
$
d. Comments
e. Electioo Sain to Dale
$
k; Required Remarks
(Iftis Une goes in line 13a of Detailed Snnunaiy Page CRO-1100 ifOpenOing Expenses)
p:his Une goes in Une 13b of Detailed Summary Page CRO-1100 ifContrib to Qmdidates/PoUtieal Comm)
(This line goes in line 13c ofDetailed Summary Page CRO-llOO ifCoordinated Party Erpfntiititn^vS
F*-Equi
bd£!^mv(^\),^^pyey
4* - Media
E - Salaries
I t/ Postage
O* . uNlONrOUNTY ^
CRO-mO fTCiARD 61- ULTO Board ofElections
C* - FundraisiDg D - To Another Candidate
G - Political Party H* - Holding Public Office Expenses '
K* - Office Expenses Q* - Donation to L^al Expense Fund
li
December 2009
Loan Repayments
Use this form to report payments on an existing loan.
Pg
Amendmentof _L [□ Yes ^ No
1. Committee Full Name (and Fimd if applicable)
itoiw -K)
3. Lender Information Add □ Remove
2. ID Number
a. Full Name, Mailing Addre^ & Phone
(inclode city2jtate, & zip)
lA^Q(4 iMiuuiu)wcL^-
e; Ranaining Loan Balance f. Acomnt Code g. Fonn of Payment h. Date (mmMd/yyyy)
b. Comments
c. Original Loan Date
d. Original Loan Amount
^ SZ)0.. oO
L Repayment Amount
■hmoh-VI- ^
3. Lender Information □ Add :□ Remove
a. Full Name, Mailing Address & Phone
(include db', state, & zip)
b. Conumnts
c. Original Loan Date
d, Ori^nal Loan Amonnt
e. Remaining Loan Balance f. Atxount Code g. Form of Paynsnt h. Date (mm/dd/yyyy)L Repayment Amonnt
3. Lender Information □ Add □ Remove
a. Full Name, Mailing Address & Phone
^dnde dty, state, & zip)
b. Comments
c. Original Loan Date
d. Original Loan Amount
e. Remaining Loan Balance f. Account Code g. Form of Payment h. Date (mm/dd^yyyy)L Repayment Amount
4. Total only this Page
5. Total of ALL CRO-1420 Pages
(This line must be on line 15 oi •age CRO-nOO)
CRO-1420
5
R1 NC State Board of ETecUons December 2007
§ie 11
BOAR
UNlQt)! QOUNf>yboard QF^lECTligWdS