Berger 2011 Mid Year Report Amendment
Disclosure Report Cover ❑ Yes Q.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
a ._ _-
b.Mailing Address(include City,State a$d Zip Code) d.Date Filed
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(.5.—)---7 n e-7 S 6y 1
/\ b 1P/0 G e.Phone Number
gin/ r , ,17 J to /�/ L CL / 1
2.Report Year 3.Period Start Date(mm/dd/yy) 4.Period End Date(mm/dd/yy) 5.Treasurer Full Name
LDtt ��i/teh li7�- 2.60 erg- -
6.Type of Committee(Check One) 9.Type of(Rep (check only one type of report from one category)
Endidate Campaign ❑ Party Municipal State/County Referendum
❑ PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational
❑ Independent Expenditure ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre-referendum
❑ Legal Expense Fund ❑ Pre-primary ❑ First ❑ Final
❑ Pm-election ❑ Second ❑ Supplemental Final
7.Type of Fund (if applicable,check one) ❑ Pm-runoff ❑ Third ❑ Annual
❑ Booster Fund Semi-annual ❑ Fourth ❑ Special
❑ Building Fund' Mid Year ..s,,,,Semi-annual
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❑ Year End Mid Year i 10.Special Report Name
❑ Other: ❑ Final ❑ Year End
8.Number of Fundraisers this Report ❑ Special ❑ Final
O ❑ Special
11.Account Information 11.Account Information
a.Financial Institution Full Name a.Financial Institution Full Name
6..1 C `"t-vll C o—
b.Purpose c.Account Code b.Purpose c.Account Code
d.Period Begin Balance d.Period Begin Balance
A'Xia ,1, c $. 31'' $
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.
/3 r ),�, /35(2 —7 6 t/)/ u of
Printed Name of Signer Signature of Appointed Treasurer pate
FOR OFFICE USE ONLY
Delivery Method
Date Received: `-1 ? (( Employee: -I. ❑ Normal Mail
Date Postmarked: Employee: ❑ Re ered Mail
and Delivered
Date Scanned: Employee: 0 Electronically Filed
Date Data Entered: Employee: In mandatory has not received
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\
RECEIVED
AUG 2 4 2011
NHC 9.(4 of Elections
Detailed Summary A❑rttenYes 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 3.ID Number
Cycle: January 1, e/( Total this Total this
Start of Election C
Y Y ' 7 Reporting Period Election Cycle
4) Cash on Hand at Start $ r 5-6 , )S3 $ 0
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
11a) Interest on Bank Accounts (CRO-1250) $ $
11b) Contributions from Not-For-Profit Organizations (CRO-1250) $ $
llc) Outside Sources of Income (CRO-1250) $ $
11d) Legal Expense Fund-Other Sources (CRO-1270) $ $
lie) Exempt Purchase Price Sales (CRO-1265) $ $
12) TOTAL RECEIPTS(Add lines 5,6,7,8,9,10,11 a,1 l b,l 1 c,l Id and Ile) $ 0 $ l"( 3L, (-6
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) $ $
18) TOTAL EXPENDITURES(Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ 0 $ t rS a 71 Cif
19) Cash on Hand at End(Add lines 4 and 12 together,then subtract line 18) $ $IN t $ 54'5-4 c S�
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) $ INK
25) Administrative Support (CRO-1710) $ $
26) Forgiven Loans (CRO-1440) $ $
27) 48-Hour Notice Reports Sum (CRO-2220) $ $
28) Contributions to be RefundedRECEIVED (CRO-1215) $ $
C State Board of Elections August 2008
CRO-1100 AUG 2 4 X111
NHC Sd 01 E'el~tions