Spreadsheet: 61d781e7-c322-42d4-8b53-dbb35ec13914
Sheet: Sheet1

Registered Committee Independent Expenditures Report | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Amendment | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28 | Unnamed: 29 | Unnamed: 30 | Unnamed: 31 | Unnamed: 32 | Page | Unnamed: 34 | _____ | Unnamed: 36 | of | _____.1
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes |  |  | No
To be used by  NC Political Committees to report all non-coordinated independent expenditures made by the committee on behalf of a candidate.
1. Committee Information
a. Full Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | c. Mailing Address (include City, State and Zip Code) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | d. NC BoE ID Number
b. Type of Committee |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | e. Total All Expenditures
 | Candidate Campaign |  |  |  |  |  | PAC |  |  |  |  |  | Party |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | $
 | Referendum |  |  |  |  |  | [NAME]
2. Expenditure Information: If filer incurred expense with a Vendor provide information below.
a. Item |  | b. Amend |  | c. Full Name, Mailing Address & Phone |  |  |  |  |  |  |  |  |  |  | d. Purpose |  |  |  |  |  | e. Candidate Information (include |  |  |  |  |  |  |  |  | f. Date |  |  |  |  | g. Amount
Num |  | Code |  | (include city, state, and zip) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] name, office sought, and declaration) |  |  |  |  |  |  |  |  | (mm/dd/yyyy)
3. In Kind Contribution Information: If filer received In Kind Contributions to further the advertisement provide information below.
a. Item |  | b. Amend |  | c. Full Name, Mailing Address & Phone |  |  |  |  |  |  |  |  |  |  | d. Purpose |  |  |  |  |  | e. Candidate Information (include |  |  |  |  |  |  |  |  | f. Date |  |  |  |  | g. Amount
Num |  | Code |  | (include city, state, and zip) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] name, office sought, and declaration) |  |  |  |  |  |  |  |  | (mm/dd/yyyy)
4. Total Expenditures THIS Page |  |  |  |  |  |  |  |  |  | (sum all the 'g' entries on this page) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | $
CERTIFICATION
Under penalty of perjury, I certify that the independent expenditures reported herein were not made with the cooperation or prior consent of, or in consultation with, or at the request or suggestion of, a candidate or a candidate's agent or authorized committee, nor did they involve the financing, dissemination, distribution or republication of any campaign materials prepared by a candidate or a candidate's agent or authorized committee.
 | Printed Name of Signer |  |  |  |  |  |  |  |  |  |  |  |  |  | Signature of Appointed Treasurer |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date
CRO-2520 |  |  |  |  |  | NC State Board of Elections |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2012-07-01 00:00:00