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Catlin Year End Report 2012 Amendment Disclosure Report Cover ❑ Yes �-'xo 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 b.Mailing Address(include City,State and Zip Code) d.Date Filed � � I C, 1 e, 4C /4 — OZ- e.Phone Number ; r Date End D d E i Peronae 2.Report Year 3.Period Start Date(�rnitld/}y) 4. 5.Treasurer Full Name (mmtddl ) ho ma, , 6.T , of Committee(Check One) 9.Ty pe of Report (check only tn one category) Ej Candidate Campaign ❑ Party Municipal State/County Referendum ❑ PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational Independent ❑ Expenditure ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre-referendum ❑ Legal Expense Fund 7.Type of Fund (if applicable,check once) ❑ Pre-primary ❑ First ❑ Final ❑ "Booster Fund" ❑ Pre-election ❑ Second ❑ Supplemental Final ❑ Building Fund ❑ Pre-runoff ❑ Third ❑ Annual Semi-annual ❑ Fourth ❑ Special ❑ Mid Year Semi-annual ❑ Other: ❑ Year End ❑ Mid Year 10.Special Rep art Name ❑ Final Year End 8.Number of Fundraisers this Report ❑ Special ❑ Final ❑ Special 11.Account Information 11.Account Information a.Financial Institution Full Name a.Financial Institution Full Name b'Purpose c Account Code b.Purpose _ff"'M c Account Code 3XM —3 s� d.Period Begin Balance JAN $4 2011 d.Period Begin Balance $ 7 CO NIHC Bd of Elections s 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 d correct rd that I have been trained by the NC State Board o Elections. 6 1,10 Printed Name of signed Signature f Appointed Tteas Date FOR OFFICE USE ONLY Date Received: `( Employee: Delivery Method Normal Mail Date Postmarked: Employee: ❑ Registered Mail 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 Amendment Detailed Summary ❑ Yes__(R_No Use this form to summarize all disclosure reporting forms and to total monetary information. 1.Committee Full Name(ame �nd Fund'if a Iicablle) 2.T 4f Report,,, /� 3.ID Number r. ( Start of Election Cycle: January 1, 1 1 Total this Total this Reporting Period Election Cycle 4) Cash on Hand at Start $ 1 C7> C $ .! C RECEIPTS 5) Aggregated Contributions from Individuals (CR0.1205) $ $ 6) Contributions from Individuals (CR0.1210) $ $ 7) Contributions from Political Party Committees (CR0.122o) $ $ 8) Contributions from Other Political Committees 1 (CR0.1230) $ $ 9) Loan Proceeds (CR0.1410) $ $ 10) Refunds/Reimbursements To the Committee (CRO-1240) $ $ 11) Other Receipt Soorces _ lla) Interest on Bank Accounts (CRO61250) $ $ llb) Contributions from Not-for-Profit Organizations (CRO.1250) $ $ llc) Outside Sourcess of Income (CRO.1250) $ $ lld) Legal Expense Fund—Other Sources (CRO-1270) $ $ 11 e) Exempt Purchase Price Sales (CRO-1265) $ $ 12) TOTAL RECEIPTS(Add lines 5,6,7,8,9,is Ila,Ilb,lic,lid and Ile) $ $ EXPENDIT 13) Disbursements 13a) Operating Expenditures — (CR0.1310) $ $ +Ov —13b) Contributions to Candidatrs/Po - �- *"— — (CRO-1310) $ $ 3, cno _ 13c) Coordinated Party Expenditures A (CR0.1310) $ $ 14) Aggregated Non-Media Expenditures (CRO-1315) $ $ 15) L---_ ------�� Zt0 e�1Of1g--...------- 13) Loan Repayments TCR _1420) $ $ 16) Refunds/Reimbursements From the Committee (CRO-1320) $ $ p� _ 17) In-Kind Contributions (CR0.151o) $ $ 18) TOTAL EXPENDITURES(Add lines 13a, 13b,13c,14,15,16 and 17) $ $ ( 4 v 19) Cash on Hand at End(Add lines 4 and 12 together,then subtract line 18) $ $ IM ADDITIONAL r' ... 20) Non-Monetary Gifts Given to Other Committees (CR0.1330) $ 21) Outstanding Loans(incl.ones from other campaigns) _ (CRO-1430) $ 2 Z 5 22) Debts and Obligations owed By the Committee (CRO-1610) $ 23) Debts and Obligations owed To the Committee (CRO-16x0) $ 24) Account Transfers Within the Committee -- — (CRO.1720) $ 2$) Administrative Support (CR0.I710) $ $ 26) Forgiven Loans (CRO-1440) $ $ 27) 48-Hour Notice Reports Sum (CRO-2200) $ $ 28) Contributions to be Refunded (CRO-1215) $ $ CRO-1100 NC State Board of Elections August 2008 'Amendment Outstanding Loans Pg of ( ❑ Yes ® No Use this form to report any outstanding loans received during a previous reporting period and until the loan is paid in full. M� mom L Committee Ftd Naing-(and Fund iLa Hcable 2.ID Number C, a, .�m m►s�icn�.r, .Lender Inf©�?gafion _ Add Remove , a.Full Name,Mailing Address&Phone b.Job TitleMrofess on d.Comments (include city,state,,&1 zip) �.` \l d-< �l�'K.�t L\ c w nom/ F`,s e Start Date(uim/dd/yyyY) ` 1 —T Prov 1 ,4E � 1 fry{ s.Employer s NaLLmelS�iegHc Field - 0-1 ` j O W L 1�C� j I h G 1 his E End Date(mm/d&yyyy) 9. 2� Rate h.Security Pledged 1.Original Loan Amount j.Remaining Loan Balance N C,1\(? $ (C (.1�1Q ' $ I C, cer Full Name of Lending Institution L Loan Number y._ nder LlfoFnatcon ;' _ Add W- a. - Full Name,Mailing Address&Phone b.Job Title/Profession d.Comments (include city,state,&ap) rG c.rr:v--)C--r/ FV C k- can { e.Start Date(mm/dd/yyyy) /Q 1 ( ' c-obi t�G �04 Yj{ �['1' c.Employer's Name/Specific Field ` "[ v (q_ 14 _1Q f.End Date(mm/dd/yM) Rate 1b.Security Pledged Ii.Original Loan Amount '.Remaining Loan Balance D % $ 'k 2, $ Full Name of Lending Institution L Loan Number 3;_Le�►der Infgrmation_. ;< :Add . . Re�ov__e, a.Full Name,Mailing Address&Phone '2 b.Job Tide/Profession d.Comments (include city,state,&zip) F JAN 14 2012 e.Start Date(mm/dd/yyyy) c.Employer's Name/Specific Field NHC Bd of Elections E End Date(mmldd/yyyy) Rate h.Security Pledged L Original Loan Amount '.Remaining Loa;IBIala;nce $ $ Full Name of Lending Institution I.Loan Number 4. Total only,this Page ' $ Z 2 1 t00 5.Total of ALL CRO-143-0 Pages CD line must be on&ne 21 of Detailed Sumnwry Page CRO-II00) i $ 1 D CRO-1430 NC State Board of Elections December 2007