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Helms,Richard_2020-1stQtrDisclosure Report Cover Oe Yes a°` ❑ No 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 undate information. 1. Committee Information . Full Name c ID Number orrr.,a, fi�eol� ����t/irt r j fv�9 8Q b. Mailing Address (include City, State and Zip Code) d. Date Filed /z i i ,eo.5`lir// 02 A/zo/Zou lv,a Xh 4 &,1/ /P C 29z/73 e. Phone Number 2. Report Year 3. Period Start Date (mm/aairy) 4. Period End Date (mm/a(/yy) 5. Treasurer Full Name 6. Type Committee (Check One 9. Type of Report (rhrrk only one type of report from one category) Candidaof te Campaign ❑ Party Municipal �tate/Comty Refereadam PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational ❑ Independent Expenditure ❑ Joint Fundraiser ❑ Thirty-five daN Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ Pre-primary Ef First ❑ Final ❑ Pre-election ❑ Pre -runoff ❑ Second Third ❑ Supplemental Final ❑ Annual 7. Type of Fund (if applicable, check one) ❑ Booster Fund Semi-annual Fourth ❑ Special ❑ Building Fund ❑ Mid Year Semi-annual ❑ Year End ❑ Mid Year 10. Special Report Name ❑ Other: ❑ Final ❑ special ❑ Year End ❑ Final 8. Number of Fundraisers this Report - - _ ❑ Special 11. Account Information 11. Account Information . Financial Institution Full Name a. Financial Institution Fall Name UNION COUNTY . Purpose c. Account Code b. , Account Code t o �� FEB 2 0 2020 yl COQ it.. Period Begin Balanced. Period Begin Balance 67 D O RECECERTIFICATION 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 th i. report is complete, true and correct and that I have been trai by the NC State Board of Elections. /_f Ile/05 S.2 �,�-� v v 2 - Printed Name of Signer Signature of Appointed Treasurer l3ate OR OFFICE USE ONLY Date Received: O Employee: Delivery Method ❑ Normal Mail Date Postmarked: Employee: Registered MailHand Delivered Date Scanned: Employee: Electronically Filed [3 Signer has not received Date Data Entered: Employee: mandato 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-210OA-E) to make committee changes. CRO -1000 NC State Board of Elections August 2008 Detailed Summit"A°1tOd1De"' ❑Yes ❑ No Use this form to summarize all disclosure reporting forms and to total monetary information 1. Committee Full Name (and Fund if applicable) 2- Type of Report 13. ID Number o�iftel��71a�la�RirJ�n.n,� Wclr�s msil'►'lq t3Q Start of Election Cycle: January 1, o/ Total this Period Total thisReporting Election Cycle 4) Cash on Hand at Start $ O $ RECEIPTS 5) Aggregated Contributions from Individuals (CRO -1205) 6) Contributions from Individuals (CRO -1210) 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) Ilb) Contributions from Not -For -Profit Organizations (CRO -1250) 11c) Outside Sources of Income (CRO -1250) lld) Legal Expense Fund - Other Sources (CRO -1270) lle) Exempt Purchase Price Sales (CRO -1265) $ $ $ $ $ $ $ $ QO6 m o $ $ $ $ $ $ $ $ $ $ $ $ $ 12) TOTAL RECEIPTS (Add fines 5, 6, 7, 8, 9,10.1 la.1 lb,l ic,l Id and I le) $ 3 pp •—= $ EXPENDITURES 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-IGnd Contributions (CRO -1510) $ Z $ $ $ $ $ $ $ $ $ $ $ $ $ 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 $ :L 9 -10 ,71Z. $ ADDITIONAL INFORMATION 0) Non -Monetary Gifts Given to Other Committees 1) Outstanding Loans (incl. ones from other campaigns) 2) Debts and Obligations owed by the Committee 3) Debts and Obligations owed to tL]NT(7"8VNTY 4) Account Transfers Within the FINANCE 5) Administrative Support FEB 2 U 2020 6) Forgiven Loans 7) 48 -Hour Notice Reports Sam R E C E I V E D (CRO -1330) (CRO -1430) (CRO -1610) (CRO -1620) (CRO -U20) (CRO -1710) (CRO -1440) (CRO -2220) $ $ $ $ $ O o $ $ $ $ $ $ 8) Contributions to be Refunded (CRO -1215) $ $ rvc sure Hoard of 8fec"ons August 2008 Ameodmem Contributions from Individuals Pg _ of _ ❑ res ❑ No Use this form to report individual contributions over $50 or contributions under $50 if forth CRO 1205 is not used 1. Committee Full Name (and Fund it applicable) 12. ID Number 6"W,If, ITS o 2".71'e e -1,114•a --a h%lAii+s Ile 4 't3 3. Contributor Information ❑ Add Remove . Full Name, Mailing Address & Phone (include city. statq b. Job IRWProfessioo d. Co is —& 1.� c'I I '& /zip) �ieJ'eQQh��2 �Nv r i{ 2/T>•t.CW S� ]VC O `D n Employees Na®NSpedBcoField �u ,/� 2 pJ/ :54 e. Rection Sum to Date Prior g.AccamuCode h. Form of Payment k�� L In Xhid Description Date (mmMd/yyyy) c Zl zoo L Amount $ 2sd • o ❑ ❑ $ ❑ $ . Contributor Information 0 Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & sip) �Y k.11,oK� A- M-01JI2oeA2 /V e,e. a2f47y' b. Job 11tie/Profession d. Comments c�mCTyees Name/Specific Field tpie,C//Vo,'fX/s uiz Eleerim s® to Date (as $ :ed oe Prior g. Account Ceek L Form of Payment L hiKind Description J. Date (mmrdd"") L Amount _ - ❑ i L°iCe 0 (b 2 d $2DD °O ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove - Fun Name, Mailing Address & Phone (include city, state, & zip) 162,111De / 'tr/ (14 b. Job 71de1Pr alcad n d Comments A / Z -e / A512- .`12-162,11 c. Employer's Name/Specific Feld e. Election Sum to Date f.prier g. Ateomt Code `Form of Payment L In -Iliad Description Date (®Iddlyyyy) q Zp20 IL Amwd $ ad L 00 13/ ex&CI UNION COUNTY GAMPAIGIII FINANCE ❑ $ ❑ $ 4. Total only this Page $ (",-N b 5. Total of ALL CRO -1210 Pages $ (This line mast be on Gne 6 of Detailed Summary Page CRO -1100) CRO -1210 NC State Board of flections 01411 Owe Amendment Contributions from Individuals pg _ of _ ❑ ,res ❑ Na Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used I. Committee Fall Name and Fesif a1 pmble) 2. ID Number / C:z19'W i -Ie f collect/ /CX/.44 �YC�is�s /,(CG 3. Contributor Information Add Remove . Full Name, Mailing Address & Phone (include city, sfak & ap) b. Job TIddProtmioo d. Comments /t�.11FF/ � Gill ✓ A.Uieru e G / SioA ,3 f t�fee it )jlee4/t� / / p' (/ , ` f9/// / /O'///J ^.. j'{1oN 2De� /Ve 2.:r c, Filo 9 Nmmffipwft Fidd lye ✓ 1r-7 eq, / e =Gcdm S® to Dote $ SDd.°s Prior g.Aecomt Code b.Fermof Palment ��eclG i. In -Kind Description J. Dae(mddd/yyyy) e/ /6 .zoza LAmount ❑ $ " d, 00 ❑ $ ❑ $ . Contributor Inforniation ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, slate, & rip) ,SO t P O rr t1 ��. a- e_ 9//3 yell (d Aloe eT 1v.�,�/i.�,t� / /✓C-- 2 8/ 2 3 b. Job 75tle(Profession fl CeWA.w. c. Emptupes NamdSpedHc Fwd Jt(p � c' e. FJeeum S® to nae P�`p�°Y` $ /cid _o Prix & Ameot Code L Form of Psyn mt t bi-Sind DM hWw Dole (mm/dWyyyy) L Amo®t ❑�c� 6/ 09 Roza $ ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & nip) ., _, ,, UNTM. CAMPAIGN FINANCE FEB 2 0 2020 RECEIVED R Job rfilwprofession d. Comments c. Employer's Name/Specific Held e. Election Sum to Date $ prier g. Account Cade b. Form o(Paymem i. fa -Kind Dm TW= Dote (mmrdill"") L Amemrt $ ❑ ❑ $ ❑ $ 4. Total only this Page $ 601) Do 5. Total of ALL CRO -1210 Pages $ 330000 (This fine must be on line 6 of Derailed Summary Page CRO -1100) CRO -1210 NC None Board 01 ntecnons Amendment Contributions from Individuals Pg _ of —0 Yes ONO Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Com®ttee IhdHNam and Zuwd if b 2. IDNumbeer / 'll /I%/ G �O eR/eU /-!CA q/e aj-n I 3. Contributor Information Lj Add 0 Remove . Full Name, Mailing Address & Phone (include city, state, & rip) b. Job TifteirProfession d. Comments °W GYc- 6ap yyn�i/s � yl -7 sr�'� e/�,c�ti /)�C ,-17149 /$ �F�,er'sN�e�ef ,d �t/� s � � C, e. Hellion cam to Date/�DAA�e Sp. ov f. Prior ❑ g. Aecoaot Code h. Ferw of Payment aec./,c L la-Ktod Devcriptioo ". Date (mmAlkift y) o o/ ae20 t Amowd l $ '6'a'90 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove . Full Nam, Mailing Address & Phone (include city, state, & zip) /1/G a 8 7S b. Job TitlefFrofession d. Comments c. Evapb� yees Name weillic Ftdd &A) io AJ v u a �ir.e..f'FP t e Election Son ta ante $ 6 00 or g.AecountCode - r h.FormofPayment L In -Kind Desuiption Date (m/ddfyM) Ic Amount r13 c� - $ .25i) m� ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove . Fug Name, Mailing Address & Phone (include City, state, & zip) 1--- - a los ,l efSA(R-c.312 b. Job TrtldProfession pp h 2- /felis2e d- ^91z- d. Comments c. Employer's Name/Specific Field c. e. Election Sum to Date $ Prier g. Account Code h. Form of Payment L In -Kind Descri i Date (nwd6WyM)_L Amari - - ❑ - - C MPAIGN FINANCE 1r. ❑ FEB 2 0 2020 $ ❑ IVED $ 4. Total only this Page 5. Total of ALL CRO -1210 Pages $ (This line must be on Use 6 of Detailed Summary Page CR0.1100) n...a xxn CRO -1210 nc. State Baru Amendment Contributions from Individuals pg _ or _ ❑ Yes ❑ No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Full Name (and Fund if a hcable) 12. ID Number ee.X.n11�0e(e 7`��/ ��ii�*�j1e/rnJ ?dee- a3iM1L4 3� 3. Contributor Information Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) A Job TItldProfessim d. Comments Powct �A?o�� i4,vu� doe -z I�11 eleele s /7r� iY1DA92Ge 1 A1C .2 t4/I -z- e. Employees Held e,.,2ele- s 219-N 4A s. Elecdam Sam t.Date -- — $ 1 fl a Frier bAccount Code h.FormorPayment ,e �L i.in-Kind Description_- Date zmaldill"") B 0 -110" LAmomat ❑ $' ODO ❑ $ ❑ $ 3. Contributor Information 0 Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) / led4y �e I,VTB 1 90� / P.a t2re..R,�s .L V O b. Job TlideWroression d. Camrah A c. Employees NamdSpe�c Ftekl �r o 7 e.x�/oY e. Election Sm to Da6e $ /Se prior g.AcrmiCade Farm of Payment Lbo-Kind Description — Date(mmldd"") LAssount ❑ -/ [ 3! $ !fie ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) 3- — F N o �C Y foo tV�K Lce WAY/Y�'"� b. Job TnlaTrotession d. Comments n / n/� ,44lo /Ccs Ri/� c.F.moe ersName,SpecifieFcetd e. Election Sumo Date $ /f✓ B . Prier g. Account Cade h Form of Payment L In Kind Description Date (mlddlyyyy) Is. Ammat E3C�eUC U111ONCOUNTY / Z ZAe za $ (DO ,0 0 ❑ If LU w $ 4. Total only this Page $ gto , do 5. Total of ALL CRO -1210 Pages $ (This line must be online 6 of Detailed Summary Page CR0.1100) CRO -1210 NC State roam of ntecuons nlwa Loan Proceeds Amendment Pg _ or ❑ Yes ❑ No Use this form to report proceeds from a loan and loan endorser's information A loan nmeeeds statement must accomnanv each loan that is from an individnal 1. Committee Full Name (and Ftmd if applicable) 2. ID Number .2J M 9 -i3 q G ont.N.1f--e 70 ele l /)lC .s, -LJ iNS ICL 3. Lender Information ❑ Add ❑ Remove . Full Nam, Mailing Address & Phone (inclu 'ty, state, & zip) b. Job Title/Profession d. Commeats en 0,M4 2 vVz e�oc,014,a-d /3Ile-W.5 /)) 1,--% j— ("'S O $G ( �� �'�' �)A k AA -w e. Start Date (mm/d(Yyyyy) % / / 3/Z J, -, a Employer's Name/Specitie Field f. End Date (mm/dd/riYY) 1z131/Z02-4) ;;. Bate ©%I JIL Security Pledged I. Account Code / j. Form of Paymeat ILAmotort IVIA T2.4Ns�zI $,-2,0 o o� . Full Name of fending Insulation Im. Loan Number 4. Endorsers/Makers (The people who guarantee the loan.) a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession c. Employer's Name(Specitic Field d. Percentage e. Amount . Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Tiae/Profession c. Employer's Name/Specific Field d. Percentage e. Aawunt . Full Name, Mailing Address & Phone (include city, state, "Pl NIouc-OURV- b. Job Title/Profession c. Employer's Name/Specific Field CAMPAIGN FINANCE FEB 2 0 2020 RECEIVED d. Percentage % e. Amount $ . Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession — c. Employer's Name/Specific Field — --- d. Percentage % e. Amount $ j 5. Total of ALL CRO -1410 Pages (This line must be on fine 9 of Detailed Summary Page CRO -1700) $ I CRO -1410 NC State Board of Elections April 2007 Amendment Disbursements Pg _ of _ ❑ Yes ❑ No Use this form to report expenditures from the committee for operating expenses, contributions to candidatelpolitical committees and coordinated nartv exnenditnrec Full Name (and Mind if applicable) 2 IDNumber ?fs�e �o/cif �tc�ia,t� f lelrt^5 l�c� �2� M 9sb_u cement (Please use separate CRO -1310 forms for each type of Disbursement) x uses Contributions [o Candidates/PoliticalConunitteesrmation pPayee Add Remove Mailing Address & Phone (include city, slate, & zip) -- - b. Coordinated Committee Name d. Comments /_ t D 0 M U -1 f7C.'2-1 e_ k c 5 jt L Owe 2 O 1 ?JC 'L if i 10 c. Level Registered (S) U Federal County: ❑ State ❑ Municipality: e. Election Sum to Date $ �S9 oa . Account Code 1 g. Form of Payment 1h. Purpose Code i. Date (mmtdd/yyyy) oz/a ��$�ggeo . Amountk. Required Remarks - — -- C� $ 4. Payee Information ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name - CL Comments c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sam to Date $ f. Account Code g. Form of Payment h. Purpose Cade 1. late (mm/dd/yyyy) . Amount $ k. Required Remarks 4. Payee Information Add 11 Remove . Full Name, Mailing Address & Phone (include city, staUA(Ap4 COUNTY CAMPAIGN FINANCE - F E B 2 0 2020 RECEIVED b. Coordinated Committee Name d. Come ue n t, a Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy)$ Amount it. Required Remarks is$ 5. Total only this Page 6. Total of ALL CRO -1310 Pages (This line goes in line l3a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 136 of Detailed Summary Page CRO -1100 if Contr(b to Candidates/Political Comm) (This line goes in line lac of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) $ 7. Purpose Codes (List detailed expenditure code in (b.) above) A* - Media B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* Other * Codes retruire detailed explanation in re uired remarks field k CK043[p NU state Hoard of Elections December 2009 ndment Disbursements Pg _ of ❑eyes ❑ No Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political committees and coordinated oartv expenditures (tiro Fmd if cable) 1. Committee Full appB 2. HD Number lNName �Oh1 Mid/G to '9/'- 3. Type of Disbursement (Please use separate CRO -1310 forms for each type of Disbursement.) O rwlng Expenses Lj Contributions to Candidates/Political Committees Coordinated Party Expenditures 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments t�`/yA) is'1�Stu� --- — L 31 ojgo T S Il 'Z_ yy� 00 12-6 C—/ N L ?01/- azs-- 06 7_3 7c.. Level Registered (Specify) I_I Federal Ej County: ElState❑ Municipality: -- 1 e. Election Sum to Date $ f. Account Code 1g. Form of Payment h. Purpose Code It. Date (mm/ddlyyyy) '. Amount 1k. Required Remarks J a- of )-7/Za2 4.'7a 'D -e -t -t 0� 0-3 Aa,z0 $ g`j'6. ?e) 4. Payee Information Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) W—S SSgt y jJ A- K k v*w N yJ .f rA I to . 2..LA S p fLt.a�r S P) e— 86o-a�f $O77 -t b. Coordinated Committee Name d. Comments _ —_-- - c. Level Registered (S ' ) Federal ff County: [3 State E3 Municipality; Municipality: e. Election Sennto Date $ ��.DD . Account Code g. Form of Payment JIL Purpose Code it. Date (mm/dd/yyyy) h. Amount L Required Remarks $ 4. Payee Information ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments u � `o w e-5 C,� %� YJ/ u 7/ L tJ T/' t l N g o -7 70 q '2—. 57-- —7 1 1D c. Level Registered (Specify) ❑ Federal County: ❑ State ❑ Municipality: — e. Election Sum to Date $ .271, it 0 . Account Code r it. Form of Payment De4,t h. Purpose Code I. Date (mm/ddlyyyy) . Amount It. Required Remarks oz a3 zaZo$:i Is s. Total only this Page $ i Zo , 2 $ 6. Total of ALL CRO -1310 Pages (This line goes in line l3a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to CandidateslPolilical Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) UNION COUNTY MMPAIGN FINANCE 7. Purpose Codes (List detailed expenditure code in (h.) above) A* - Media B* - Printing C* - Fundraising D - To Anot\/ E - Salaries F* - Equipment G - Political Party H* - Holding cit ses I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* Other * Codes reattire detailed explanation in rc uired remarks Geld k CRO -1310 NC State Board of Elections December 2009 Amendment Outstanding Loans Pg of _ ❑ 1. ❑ No Use this form to report any outstanding loans received during a previous reporting period and until the loan is paid in full. L'Committee Fall Name (and Ftitnd if applicable) 12.ID Number 3. Lender Information ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Professlon e d. Comments Z/ Z W4 -3C H C l{ ti Y' p e. Start Date (mm/dd/yyyy) c. Employer's Name/Specifie Field / / L D 2 ;z O{ L Eod Date (mm/dd/yyyy) Ix/31 /ZO 2— J_ . Rate JIL Security Pledged I. Original Loan Amount J. Remaining Loan Balance k. Full Name of Lending Institution I. Loan Number 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Titleli'rofession d. Comments e. Start Date (mn)lddtyyyy) c. Employer's Name/Specific Field I. End Date (mm/dd/yyyy) ;;. hate % h. Security Pledged 1. original Loan Amount J. Remaining Loan Balance $ $ l:. Full Name of Lending Institution 1. Loan Number 3. Lender Information ❑ Add 13 Remove - . Full Name, Mailing Address & Phone (include city, state - CAMPAIGN Q NA CE -- ------ FEB 2 0 2020 RECEIVED b. Job Tide/Profession d. Comments e. Start Date (mmtddtyyyy) a Employer's Name/Specifie Field f. End Date (mm/ddtyyyy) g. Rate % h. Security Pledged ji. Original Loan Amount J. Remaining Loan Balance $ $ k. Full Name of Lending Institution 1. Loan Number 4. Total only this Page $ S. Total of ALL CRO -1430 Pages (This line must be on line 21 of Detailed Summary Page CRO -1100) $ CRO -1130 NC State Board of Elections December 2007 PTH CAR STATE BOARD ELECTIONS Loan Proceeds Statement This Statement is used to report detailed information about a new loan and is required to accompany the Loan Proceeds Form in the report for which the loan is initially disclosed. If the loan is from an individual, the lender's signature is required on this form. This Statement is to be filed with the Election Board where the committee's reports are filed. • Name of committee to receive loan: 70 ��/(�c1r,¢�,�rfr,r u • Person or committee to make loan: 4 s /z • Date of loan to committee: 1413/7-11 zo • Name of lending institution and account number (source): • om Amount of loan: • Description (if in-kind loan): • Names of all parties responsible for payment of loan (guarantors): • UNION COUNTY Period of loan: CAMPAIGN FINANCE • Rate of interest of loan: Zj F�B2n gon • Security pledged for loan: I, /t '�/ 2 2� 62 17-c 6At5 S`L acknowledge that all of the information (Person lending money to committee) provided is complete, true, and accurate. I further understand I may not forgive a loan that hasarry outstanding balance to any source. of Lender of Treasurer of Committee CRO -6100 Loan Proceeds Statement / -& 10 Date Signed ly0fyoza Date Signed