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2012 Year End Report Amendment Disclosure Report Cover ❑ Yes 121 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 update information. 1.Committee Information a.Full Name c.ID Number .0r1M;li-6 ( E( tCc Cll Atr'i ch i '/ 4 )1" -C-0�:�I L.Mailing Address(include City,State and Zip Code) d.Date Filed L( OO +sky 1)� f Y 0l//4/a�/5 a,i t VIt„ 0 L cfcj 9 e.Phone umber I o. 7i/ .55 .V/ .. rlod Start Date-(mmtddlyy) 4.Period End Date(mmtddtyy) 5.Treasurer i e�a ©rf t 1r.:1, . / . 7oy•,�i1/ / .1:51).716-- . &_(--d, 5 ° =,One) 9.Type of Re t (check only one type of report from one category) 1 NI Candidate Campaign ❑ Party Municipal State/County Referendum O PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational ❑ Independent Expenditure ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre-referendum ❑ Legal Expense Fund ❑ Pre-primary ❑ First ❑ Final ❑ Pre-election ❑ Second ❑ Supplemental Final ❑ Pre-runoff ❑ Third ❑ Annual ❑ Booster Fund Semi-annual ❑ Fourth ❑ Special ❑ Building Fund pr.......lgid Year Semi-annual Year End ❑ Mid Year 10.Special Report Name ❑ Other: ❑ Final ❑ Year End 8.Number of Fundraisers this Report ❑ Special ❑ Final ❑ Special 11.Account Information 11.Accou a.Financial Institution Full Name a.Financial Institution Full Name e„,„17_,,,4 b.Purpose c.Account Code b.Purptls b U b \i E D c.Account Code l F 5� 6 _ JAN 16 2013 d.Period Begin Balance d.Period Begin Balance $ / ',VIP NHC Bd of Elections $ 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 trained by the NC State Board of Elections. 5 fir k✓/h' � - . ZC LA.);,' 4 c e�/i.(0 / Printed Name of Signer Signature of Appointed Treasurer Da 7 ate FOR OFFICE USE ONLY > -�y� Deliver Method Date Received: i iLbti 3`i Employee: 7- A, El Normal Mail I Date Postmarked: Employee: ❑ Registered Mail L1, Hand Delivered Date Scanned: Employee: ❑ Electronically Filed ❑ Signer has not received Date Data Entered: Employee: mandatory 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-2100A-E)to make committee changes. CRO-1000 NC State Board of Elections August 2008 5 Detailed Summary Amendment Qi 0 Yes 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 3.ID Number D M41; tfat Ekc-f et471-5 4 fr;JX-A Xz.-61 d ,f/ 14)cdk y /5:coo 1 Start of Election Cycle: January 1, 420/0 Total this Total this Reporting Period Election Cycle 4) Cash on Hand at Start $ 1Y."2„ li? $, ,5151/ () RECEIPTS 5) Aggregated Contributions from Individuals (CRO-1205) $ 6) Contributions from Individuals (CRO-1210) $ $ /60 60 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 11a) Interest on Bank Accounts (CRO-1250) $ 11b) Contributions from Not-For-Profit Organizations (CR0-1250) $ RECEI 11c) Outside Sources of Income (CRO-1250) $ JAN 1 6 U13 11d) Legal Expense Fund-Other Sources (CRO-1270) $ !' 11e) Exempt Purchase Price Sales (CRO-1265) $ 12) TOTAL RECEIPTS(Add lines 5,6,7,8,9,10,11a,11b,11c,11d and 11e) $ $ A)0 ,00 EXPENDITURES 13) Disbursements 13a) Operating Expenditures (CRO-1310) $ $7W 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) $ $ /00„ 3O 18) TOTAL EXPENDITURES(Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ $ (2, ../-0 19) Cash on Hand at End(Add lines 4 and 12 together,then subtract line 18 $ $ yA.() ADDITIONAL INFORMATION ) 20) Non-Monetary Gifts Given to Other Committees (CRO-1330) $ 21) Outstanding Loans(incl.ones from other campaigns) (CRO-1430) $ 22) Debts and Obligations owed by the Committee (CRO-1610) $ 23) Debts and Obligations owed to the Committee (CRO-1620) $ 24) Account Transfers Within the Committee (CRO-1720) $ 25) Administrative Support (CRO-1710) $ 26) Forgiven Loans (CRO-1440) $ 27) 48-Hour Notice Reports Sum (CRO-2220) $ 28) Contributions to be Refunded (CRO-1215) $ CRO-1100 NC State Board of Elections August 2008