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Amburgey,Tom_2025-Final AmendedAmendmentDisclosure Report Cover WLycs n no Use this form for general report and committee information, must be signed and submitted along withother detailed forms. DojloLuseihisfonnto update information. 1. Committee Information a. Full Name c. ID Number >. Mailing Address (Include City, State and Zip Code)d. Date Filed /Oi:i Coi^^rSal H r<. 7nc..'l e. Phone Number 7^"/' 2. Report Year 3. Period Start Date fmm/dd/w) 4. Period End Date (mm/dd/w) S. Treasurer Full Name 6. Type of Committee (Check One) ^ Candidate Campaign Pany □ PAC □ Referendum□ Independent Expenditure ^ Joint Fundraiser □ Legal Expense Fund 7, Type of Fund (if applicable, check one) □ Booster Fund □ Building Fund n Other: 8. Number of Fundraisers this Report 9. Type of Report (check only one type ofreport-from one cdtegoiy) Municipal State/County Referendum □ Organizational □ Thirty-five day □ Pre-primary □ Pre-election n Pre-runoff Semi-annual Mid Year rn Year End ^ Final n special □ Organizational Quarterly n First n Second□ Third Q Fourth Semi-annual n Mid Year n Year End n Final n Special i~| Organizational □ Pre-referendum n Final □ Supplemental Final □ Annualr*l Special 10. Special Report Name 11. Account Information 11. Account Information a. Financial Institution Full Name a. Financial Institution Full Name b; Purpose G tO c. Accoutit Code b. Purpose d. Period Begin Balance $ 5^7-7^ c. Account Code d. Period Begin Balance (^RXmCATION 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. I further certify that this report is complete, true and correct and that I have beejtMitfeg" by tfit NG^tate Board of Elections. Printed Name of Signer "Si^atur^^ppoinle^^^ FOR OFFICE USE ONLY Date Received: Date Postmarked: Date Scanned: Date Data Entered: Employee: Employee: Employee: Employee: Delivery Method □ Normal Mail'i~l Registered Mail n Hand Delivered -□ Electronically Filed □ Signer has not received ' • mandatory training Please Note: This form cannot be used to amend committee information such as the committee address, treasurer, a^^t treasurer, custodian of books information, or account information.RoGfcimiEatl the Statement of Organization (CRQ-2100A-E) to make committee changes. CRO-IOOO DEC 1 1 2025 UNION COUNTY BOARD OF elections NC State Board of Elections August 2008 Detailed Summary Amendment S Yes □ No 1. Cbininittee Full Name (and Fund if applicable)2. Type of Report ; '3. ID Number /\ynb Start of Election Cvcle: .Tanuarv ^ ^Total this Reporting Period Total this Election Cvcle 4) Cash on Hand at Start $ ^9,7^$ RECEIPTS ^ . ... . , ^ 5) Aggregated Contributions from Individuals (CRO-1205)s $ 6) Contributions from Individuals (CRO-1210)$ ¥37A[$ 7) Contributions from Political Party Committees (CRO-1220)$$ 8) Contributions from Other Political Committees (CRO-1230)$$ 9) Loan Proceeds (CRO-1410)$$ 10) Refunds/Reimbursements to the Committee (CRO-I240)$$ 11) Other Receipt Sources ■BHHH 11a) Interest on Bank Accounts (CRO-I250)$$ lib) Contributions from Not-For-Profit Organizations {CRO-nsO)$$ 11c) Outside Sources of Income (CRO-I250)$$ lid) Legal Expense Fund - Other Sources (CRO-I270)$$ lie) Exempt Purchase Price Sales (CRO-1265)$$ 12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8. 9,10,11a,lib,11c,lid and 11 .$ EXPENDITURES \r • 13) Disbursements 13a) Operating Expenditures (CRO-13IO)$$ 13b) Contributions to Candidates/Political Committees {CRO-1310)$$ 13c) Coordinated Party Expenditures (CRO-1310)$$ 14) Aggregated Non*Media Expenditures (CRO-J315)$$ 15) Loan Repayments (CRO-1420)$$ 16) Refunds/Reimbursements from the Committee (CRO-I320)$ 5^7.7^$ 17) In-Kind Contributions (CRO-ISIO)s- V-3-7.M $ 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)$ 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18'$ ADDITIONAL INFORMATION v : %■ ■ 20) Non-Monetary Gifts Given to Other Committees (CRO-I330)$ 21) Outstanding Loans (inch ones from other campaigns)(CRO-1430)$■■mmm 22) Debts and Obligations owed by the Committee (CRO-I610)$■HBIHI 23) Debts and Obligations owed to the Committee (CRO-I620)$■■HBH 24) Account Transfers Within the Committee (CRO'1720)$ 25) Administrative Suppopjpppi^pp^(CRO-17IO)$$ 26) Forgiven Loans (CRO-I440)$$ 27) 48-Hour Notice Repor^felnn' 1 (CRO-2220)$$ 28) Contributions to be Re^pR^ nnuNTY (CR0-I2IS)$$ CRO-1100 BOARD OF ELECTIONS NC State Board of Elections August 2008 Reset Form Refunds/Reimbursements From the Committee pg of _ Use this form to report refunds/reimbursements, including contributions returned to the contributor. Amendment □ Yes □ No l.-Gommittee Full Name (and Fund if apulicable)2. ID Number ' J ^ fVirckiuX 3. Payee Information [iJ Add |LJ Remove - a. Full Name, Mailing Address & Phone ' (Include city, state,,& zip) d; Type of Committee h. Original Receipt Date kd Candidate |_J PAC n Referendum CD Party e. Level Registered i. Original Receipt Amount 1 1 Federal |_J County: O State i>^MuniciDalitv:$ f. Purpose Code j. Election Sum to Date. , - - ' $ b. Job Title/Profession c. Employer's Name/Specific Field g.'^Conunents .k. Account Code 1. Form of Payment m. Required Remarks 'n. Date (nun/dd/yyyy)0. Amount $ 57'?'^ 3. Payee lufonnatlpn . . ]□ Add ]□ Remove a. Full Name, Mailing'Address & Phone (include city, state, & zip) d. Type of Committee h. Original Receipt Date 1 1 Candidate | | PAC n Referendum Party e. Level Registered i. Original Receipt Amount 1' 1 Federal LI County: n State CD Municipality:$ f. Purpose Code j. Election Sum to Date. $ b. Job Title/Profession c. Employer's Name/Specific Field g. Comments k. Account Code i. Form of Payment -m. Required Remarks n. Date (mm/dd/yyyy) i 0. Amount.; $ 3. Payee Information !□ Add ]□ Remove • . a. Full Name, Mailing Address & Phone (include city, state, & zip) ' d. Type of Committee .h. Original Receipt Date ' 1 i Candidate LJ PAC n Referendum D Party e. Level Registered i. Original Receipt Amount 1 1 Federal |_i County: n State L] Municipality:$ f. Purpose Code j. Election Sum to Date $ b. Job Title/Profession c. Employer's Name/Specific Field g. Comments k. Account Code 1. Form of Payment m. Required Remarks n. Date (nun/dd/yyyy) '0. Amount $ 4. Total only this Page 5; Total of ALL CRO-mO Pages (Thisline must be on line 16 ofDetailed Summary Page CRO-1100) ^ ^ fCfS s SlJ^ 6. Purpose Codes (Lisj detailed disbursement code in (f) above)" ^ " - L - Returned to Contributor- ■' M - Overpayment for Servit^j-p a » oniR N -ExceededContribution Limit P* - Reimbursement of In-IOnd 6* Other ' ; * Codes reouire detailed exnlanation in reauired remarks field (mL... r^r>i »mty In-Kind Contributions Use this form to report non-monetary contributions, donations, goods or services provided to the committee or fund. Pg of Amendment ia Yes □ No 1. Committee Full Name (and Fund if applicable)2. ID Number . ' 3. Contributor Information ]□ Add [LI Remove v a..Full Name, Mailing Addr^ & Phone (include city, state, & zip) b. Type of Contributor c. Comments r 1 Individual Candidate n Party □ PAC n Referendum n Other Receipt Source d. Election Sum to Date - $ e. Description . ■' .f. Date (mm/dd/yyyy)g. Fair Market Amount ^ d-G.QS li.00^5'/0/^3U'> ^6' ^T^rr)CrroL^/oile(-xc-iS « St02,l^ 3. Contributor Information jLJ -Add II 1 Remove . ^ a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Contributor c. Comments 1 1 Individual n Candidate n Party □ PAC n Referendum n Other Receipt Source d. Election Sum to Date $ e. Description ., , ' / . , • ''f. Date (ihm/dd/yyyy) .g. Fair Market Amount % % 3. Contributor Information ]□ Add ]□ Remove " _ , a. Full Naihe, Mailing Address & Phone . (include city, state, & zip) ' " b. Tj'pe of Contributor - " -c. Comments lU Individual n Candidate n Party □ PAC n Referendum n Other Receipt Source d. Election Sum to Date - $ e. Description 'f. Date (mm/dd/yyyy)g. Fair Market Athount Ck // /3-/Vv74 ^ prrrix/rn $ nLULIVLU $ 4. Total only this, Page LItU 1 V .5 ^21.'/ 5. Total of ALL CRO-1510 Pages union county ■ {This line must be on line 17 ofDetailed Summary Page ©BAHK^JDF ELECTIONS.'$ 'j^37wr