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Blumer,Terri_2026-Third Qtr & Final ReportAmendment Disclosure Report Cover Yes ®Nn 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 u date information. 1. Committee Information a.. Full Name - c. [D Number '167RR) Blom . FOP -2 'S'U)06 DSM q9 l b. Mailing Address (include City, State and Zip Code)" - d. Date Filed 32,z9 KAY -EN LANE 1())Z?) z02.ca as— I ) D e. Phone Number "26Z4-505 -2.x32 2. Report Year 3. Period §tart Date mm/d 14. Period End Date (mmtddt 5. Treasurer Full Name ' 202(0 q),)) lo6z& i v i2 Y,& 1301 fq&g 6._Type,of Committee (Check One) 9.. Type of Report' check only one type -of report from one-category) Candidate Campaign © Part © PAC Referendum Qindependent Expenditure © Joint Fundmiser ® Legal Expense Fund Municipal State/County Referendum Organizational © Thirty-five day Pre-primary Pre-election © Pre-mnoff Semi-annual © Mid Year ® Organizational Quarterly ® First ® Second ® Third © Fourth Semi-annual Organizational Q Pre -referendum © Final ® Supplemental Final ® Annual ® Special 7. Type of Fund (if applicable. check one) Booster Fund Building Fund ❑ Other. © Year End Final Special ® Mid Year ® Year End ® Final 0 Special 10. SpecialReport Narne 8. Number of Fundraisers this Report 11. Account Information 11.,Account Information a. Financial Institution Full Name a. Financial Institutio�ull.Name r I)2S % l %J ows ggvx� N10 o53 NpNCE b. _Purpose C�n�1�.�l�etl. i(Q �V!'rM tali c. Account Code - " / u b �` `1c �r^�, V ` R v e. Account Code-' di Period Begin Balance d. Period Begin Balance. $ �`}2,6D $ 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 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 been tr ' e by the S e oard of Elections. / 7p(w) &4jma /D 27 ZvZG Printed Name of Signer Signature of Appointed Treasurer I Dfate FOR OFFICE USE ONLY ) �Q Date Received: Wall %l )U Employee: �` 1/r/tt� Delivery Method ❑ Normal Mail Date Postmarked: Employee: ❑ Registered Mail Hand Delivered Date Scanned: Employee: ❑ Electronically Filed Date Data Entered: Employee: ❑ Signer has not received mandatory training, Please Note: This form cannot be used to amend comtnittee information such as the comtnittee 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 Detailed SummaryAmYes [:I No endment 0 Use this form to summarize all disclosure re or[in forms and to total moneta info[' r 11Iryrma 1. Committee Full Name (and Fund if applicable) 2. Ty a of Report,3. on ID Number I ER21 130mg FOR (f1)LTx & 4 3 `� Q i 2 �iN�}L W dmf 1+& I. Start of Election Cycle: January 1, Total this Re orting Period Total this Election Cycle 4) Cash on Hand at Start $ '20-12" $ RECEIPTS 5) Aggregated Contributions from Individuals (CRO -1205) $ $ 6) Contributions from Individuals (CRO -1210) $ O $ 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 -1240) $ $ 11) Other Receipt Sources Ila) Interest on Bank Accounts (CRO -1250) $ $ llb) Contributions from Not -For -Profit Organizations (CRO -1250) $ $ Ile) Outside Sources of Income (CRO -1250) $ $ 11d) Legal Expense Fund - Other Sources (CRO -1270) $ $ Ile) Exempt Purchase Price Sales (CRO -126S) $ $ 12)TOTAL RECEIPTS (Add lines 5,6,7,8,9,10,1 la,l lb,l le,l Id and Ile) $ D $ EXPENDITURES, 13) Disbursements -� 13a) Operating Expenditures (CRO -1310) $ $ 13b) Contributions to Candidates/Political Committ (CRO -1310) 13c) Coordinated Party Expendit r NION�NN Ur FINANCECRO-1310) $ $ $ $ D $ $ $ $ 14) Aggregated Non -Media Expenditures 2Q26 (CRO -1315) 15) Loan Repayments _�T r7 (cR0.1420) 16)Refunds/Reimbursementsfromt eedaEC..UVED (cRo-1320) $ -40,00 $ 17) In -Kind Contributions (CRO -1510) $ $ 18) TOTAL EXPENDITURES (Add lines 13a, tab, 13c, 14, 15, 16 and 17) $ $ 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18 $ 1 $ ADDITIONAL INFORMATION ., 0) Non -Monetary Gifts Given to Other Committees (CRO -1330) $ 1) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) $ 22) Debts and Obligations owed by the Committee (CRO -1610) $ 3) Debts and Obligations owed to the Committee (CRO -1620) $ 24) Account Transfers Within the Committee (CRO -1720) $ 5) Administrative Support (CRO -1710) $ $ 26) Forgiven Loans (CRO -1440) $ $ 7) 48 -Hour Notice Reports Sum (CRO -2220) $ $ 28) Contributions to be Refunded (CRO -1215) $ $ VU NC state noaru or mecuons August 2008 Amendment Refunds/Reimbursements From the Committee pg _ of _ ❑Yes ❑ Na Use this form to report refunds/reimbursements, including contributions returned to the contributor. L.,Committee Full Name (and Fund if-applieable) G 5,ff'l Uyd l� SGI107t � 600,0 12.-IDNumber 3. Payee Information ' I❑ Add Q Remove a. Full Name,. Mailing Address & Phone - (include city, state; & zip) _ lf)e� rlG 7 R O 7 LuN� l`y '��i Vim( AN I wL /4 it. Type. of Committee h. Original Receipt. Dale Candidate Ll PAC ❑ Referendum 13 Party e. Level Registered. i. Original Receipt Amount Federal 0 County: ❑ State ❑ Municipality: $ C Purpose C de j. Election Sum to Date �p $ b. Job Title/Profession. - c Employer's Name/Specific Field • gl Comments k. Account Code CEO 8a1(Ae,` uC 6 Y-6, 1, Form of Payment lin. Required Remarks n. Dale (nr dd/yyyy) o. Amount CIf�CIcI F1 &1106 FEE 'J- MIS I 7 ro adzm $ 8'42,00 3. Payee Information I❑ Add .I❑ ,Remove a. Full Name, Mailing Address &.Phone - - (include city, state, &.zip) - it. Type of Committee h. Original Receipt Date Candidate PAC ❑ Referendum ❑ Party UNION COUNTY CAMPAIGN FINANCE 7 q 7 2U26 OCT L r L RECEIVED e. Level Registered i. Original Receipt Amount EI Federal county: [3 state ❑ Municipality: $ f. PurposwCode j. Election Sum to Date $ b. Job TilletProfession c. Employer's Name/Specifle Field g. Comments k. Account Code (. Form of Payment m. Required Remarks in. Date (mm/dd/yyyy) lo.Amount $ 3.'Payee Information 10' Add I❑ _Remove a. Full Name, Mailing Address & Phone (include city, state, &zip) it. Type of Committee h. Original Receipt Date L1 Candidate PAC ❑ Referendum ❑ Party e. Level Registered i. Original Receipt Amount D Federal L1 County: [:]State ❑ Municipality: $ C 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 In. Date (rmn/dd/yvyy) o. Amount $ 4. Total only this Page $ Z, 5. Total of ALL CRO -1320 Pages (T Its file mast be on lute 16 of Detailed Summary Page CRO -1100) $ 6. Purpose Codes(List detailed disbursement:code in (f) above) _Z7- I _ L - Returned to Contributor _ _ M - Overpayment for Service N - Exceeded ContributionLimit P* - Reimbursement of In -Kind O* Other * Codes re uire detailed ex lanadon inrequired remarks:6eld m CRO -1320 NC State Board of Elections December 2007