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Organizational Report 7-2-21ndment Disclosure Report Cover p Yes p 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 Fun Name c. ID Number h. ^I f , r rico/Alel ( , / l.0 V -T VV /Q, /J . Mailing Address (iadu a Qty, S sod 7Jp Code) d. Date Filed L'064 , L 6-k-0 oc— D!& ` l -y] e. phone Number L (7 2. Re rt YearIll. Period Staft Date (tool 4. Period End Date (mud ) 5. Treasure arae of Committee Check One _ _ of Re rt (check only one a of re ort from one category) C andidate Campaign ❑ Parry Muni at State/County Referendum ❑ PAC ❑ Referendum Organizational ❑ Organizational ❑ Organizational ❑ Independent Expenditure ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ Pre-primary ❑ Furs ❑ Final ❑ Pre-election ❑ Pre-mnoff ❑ Second ❑ Third ❑ Supplemental Final ❑ Annual i. Ihn of Fund (if applicable, check one) _ ❑ Booster Fund Semi-annual ❑ Fourth ❑ Special ❑ Building Fond [3 Mid Year Semi-annual ❑ Year End ❑ Mid Year 10. Special Report Name 13 Other: ❑ Final Special ❑ Year End E]Final 8. Number of Fundraisers this Report_❑ ❑ Special 11. Account Information 11. Account Information . Financial Institution Fall Name a. Financial Institution Flo Name L . Purpose c. Account Code b. Purpose e. Account Code i _ n CC`s , �t r� , ^� V lJ d. Period Begin Balantx d. Period Begin Balance a $ CERTIFICATION I certify that the Conunittee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 2213-22M of Chapter 163 of the NC General Statutes and that no funds are commingled with prohibited or other non -disclosed funds. 1 further certify that this report isill complete, we and correct and � thhhat I he a been trained by NC State Board of Elections. VI a etlc L Printed Name of Sigm St nature of ted T r gate OR OFFICE USE ONLY Date Received: I Iq Employee: Delivery Method ❑ Normal Mail TKIRegistered Mail Date Postmarked: Employee: Hand Delivered Date Scanned: Employee: Electronically Filed nernot Date Data Entered: Employee: mandatoas oy tLIMIrneneived 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 Summa Amendment rY C3 Yes ❑ No Use this form to summarize all disclosure rennrtine forms and to total mnnetam infnrmatinn 1. Committee Full Name (and Fund if applicable) aaaaaMW 2. Type of Report 13. ID Number Start Of ElectionCycle: January 1, Total this Re4rtipg Period Total this Election C cle 4) Cash on Hand at Start 1 $ YJ$ RECEIPTS 5) Aggregated Contributions from Individuals 6) Contributions from Individuals 7) Contributions from Political Party Committees 8) Contributions from Other PoBtical Committees 9) Loan Proceeds 10) Refunds/Reimbursements to the Committee Ii) Other Receipt Sources Ila) Interest on Bank Accounts 1lb) Contributions from Not -For -Profit Organizations I lc) Outside Sources of Income I ld) Legal Expense Fund - Other Sources Ile) Exempt Purchase Price Sales (CRO -1105) (CRO -1110) (CRO -1220) (CRO -1230) (CRO -1410) (CRO -1140) (CRO -1250) (CRO -1250) (CRO -1150) (CRO -1270) (CRO -1265) $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10,11 a,1 I b,l lc,l Id and I le $ - $ 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 -Kind Contributions (CRO -1510) $ $ $ $ $ $ $ $ $ $ $ $ $ 5 $ 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 0) Non -Monetary Gifts Given to Other Committees 1) Outstanding Loans (incl. ones from other campaigns) 2) Debts and Obligations owed by the Committee Debts and Obligations owed to the Committee 24) Account Transfers Within the Committee 5) Administrative Support 6) Forgiven Loans 7) 48 -Hour Notice Reports Sum (CRO -7330) (CRO -1430) (CRO -1610) (CRO -1620) (CRO -7720) (CR0.1710) (CRO -1440) (CRO -2220) $ $ $ $ $ $ $ $ $ $ $ 8) Contributions to be Refunded (CRO -1215) $ $ CRO -7700 NC State Board of Elections August 2008 Amendment Contributions from Individuals Pg —of _ ❑ Yes ❑ No Use this fort to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Fult Name and Fund if applicable) 2. ID Number C 3. Contributor Information 0 Add U Remove . Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Tille/Profemion d. Comments �,a- r 5 t 2c.� C-� . C.� c. Employer's Name/Specific Field e. Election Sum to Date L Prior g. Account Code h. Form of Payment I. In -Kind Description J. Date (mm/ddlyyyy) k Amount ❑ i -1 T ia $ $ V -5-'\'O 3. Contributor Information " ❑ Add 0 Remove . Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title(Profemiou d. Comments c. Employer's Name/Specific Field e. Election Sam to Date I. Prior g. Account Code h. Form of Payment 1. In -Kind Description J. Date (mm/dd/yyyy) k Amount ❑ $ ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title(Profession d. ('ununcnb c. Employer's Name/Specific Field e. Election Sum to Date f. Prior ❑ g. Account Code h. Form of Payment I. In -Kind Description J. Date (mmfddfyyyy) k Amount $ ❑ $ ❑ $ 4. Total only this Page S 5. Total of ALL CRO -1210 Pages $ /� (This line must be on line 6 of Detailed Summary Page CRO -1/00) ud CRO -/210 NC State Board of Elections April 2007 Aniendmcnt In-Kind Contributions Pg _ of _ ❑ N ❑ `, Use this form to report non -monetary contributions, donations. goods or services provided to the committee or tund. Use CRO -1215 if In -Kind Contributions were or will be refunded within 7 daNz 1. Committee Full Name (and Fund if applicable) 2. ID Number 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phonee (include city, state, & zip) b. T of Contributor c. Comments Individual ❑ Candidate ❑ PACs ❑ Referendum ❑ Other Receipt Source C ' d. Election Sum Date $ ,V . Description f. Date (mm/dd/yyyy) g. Fair Market Amount 1 v�C s CJ „��� ���U�l $ , v�) $ $ 3. Contributor Information ❑ Add ❑ Remove . Full Name, :flailing Address & Phone (include city, state, & zip) b. Type of Contributor c. Comments Individual ❑ Candidate ❑ Ply ❑ PAC ❑ Referendum ❑ Other Receipt Source d. Election Sum to Date $ . Description f. Date (mm/ddlyyyy) g. Fair Market Amount 3. Contributor Information ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Contributor c. Comments L3 Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source d. Election Sum to Date $ . Description f. Date (mm(dd/yyYY) g• Fair Market Amount $ $ 4. Total only this Page $ 5. Total of ALL CRO -1510 Pages (This line must be on line 17 of Detailed Summary Page CRO-110Ib CRO -1510 M Gale RDecember 2007