‘ Ameadmeat Disclosure Report Cover MCcoPy as Bw Use this form for general report and committee information, must be sighed and submited along with other detailed forms, Do not use this form to update information Tommie Information _FultName PERE TERR 31 [et Number = Ted Van Dyk Election Commitice VED 1 |. |__ SP 2 8 7009 | 7 i Nang Aalr(cade Cig, Stead ip God) Tate Fied PO Box 12286 7 _ ~ | Raleigh, NC 27605-1228 928109 ‘Phone Nomber | 919-831-1308 eport Year eriod Start Date (mm 4: Period End Date | 5. Treasurer Full Nam: Report Year _|3-Pevid Sart Datecamunyy | EPeog [st Fall Name S am | 109 aan |" Micheline Bohnaker — | —————— © Type of Committee (Check One) ype otReport he ne type of report from one categon) BJ CandidateCarpaien CJ Pany Manic ‘State/County ‘Referendum _ O rac CF tetentom FLY Gamat PL) Oman | PLY Onno Gl ceca Dine Fundsaiser | [J Thiny-tive day Quarterly C1 Preseferendum T]_tetat expense Fund a 7 Type of Fund applaabie cet |] Pee rinay Oras OO Fra Coser Fun BI Preeteston second ()Swppemenat ina Ch ating Fue CO Prenmnot O twa CE) anmuat servant = |] Fourth ) OD Specie Lh Midyear | Semanal O vered = | Ma'Year 10. Special Report Name | Ol Fina | vearead Ol speci Ona sees | TV. Account Fao Ti, Account Information 2: Fine nsittion Fall Name = Finan attain Full Name - ‘North State Bank —_ Be Furpose [Account Code Fare TT eco oae 1 Expenses | cK Period Begin Balance dc Period Begin Balance $1323.83 8 CERTIFICATION | certify that the Committee or Fund is in compliance with all applicable provisions of Article 22, 22B, & 22D-22M of Chapter 163 of the NC General Statutes and that no funds are commingled with prohibited or other jon-disclosed funds, f further certify that this report is complete, rue and correct and that ! have been trained by the NC Micheline Bohnaker 9725109 Printed Name of Signe ee Dae FOR OFFICE USE ONLY Delivery Method Date Received! Employee: ——— LD Normal Mail Registered Mail Date Posmari Employee F fantbelvera Electronically Filed DaeSemed: mts By Sieh ered mandatory training Date Data Entered: Employee: 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 TNC State Boars of Elections Tone 2008Detailed Summary Amendment O vs Gl % 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 3.1D Namber Ted Van Dyk Election Committee Pre-Election a ; , “Total this tart of Election Cyel January 1, 2009 Reporting Period ele 4) _Cash on Hand at Start 13) Disbursements 13a) Operating Expenditures $s 13232.83 $ 5) Aggregated Contributions from Individuals (CRO-1205) | $ Ss 160.00 6) Contributions from Individuals (cro-2 [§ 1210894 S_32634.94 7) Contributions from Political Party Committees (cro.122y | § 100.00 s 10000 —& 8) Contributions from Other Political Committees: (€RO-1230) | § = $ 9) Loan Proceeds (CRO-1410) | $ s — 10) Refunds/Reimbursements To the Committee (CRO-1240) | S : 3 11). Other Receipt Sourees 1a) taterest om Bank Aecounts cron | 110) Comttons fom NovforProft Organizations (eros |S te) Outside Sources oF ncome — 11d) Legal Expense Fund - Other Sources {€RO-1270) | $ - | s Ite} Exempt Purchase Price Sales (CRO-1265) | $ 3 - 12) TOTAL, REC! $ |s = cono.tsiy | S$ 13526.11 S$ 2079480 13b) Contributions to Candidates/Political Committees (CRO-131) | 3 7" s 13e) Coordinated Party Expenditures (CRO-1310) | $ $ ” | 14) Aggregated Non-Media Expenditures 1cr0-1315) | § ts 15) Loan Repayments ccro.ray |S \s | 16) Refunds/Reimbursements From the Committee (cxo-1320 | $300.00 530000 17) In-Kind Contributions ccro.isiy |S 2818.94 S230 | 18) TOTAL EXPENDITURES (4d ines 1a 198 16 14.15 16a 19) 51668505 s_m0i74 | 19) _Cash on Hand at End (Add ines amd 12 gtr, hen nba ine 18) S_ 885721 S__ sev) Non-Monetary Gifts Given to Other Committees, 21) Outstanding Loans (incl. ones from other campaigns) 22) Debts and Obligations owed By the Committee 23) Debts and Obligations owed To the Committee 24) Account Transfers Within the Committee 25) Administrative Support 26) Forgiven Loans 27) 48-Hour Notice Reports Sum 28) Contributions to be Refunded CRO-TI00 TC Sie Bondo sans (€RO-1330) (CRO-1430) (CRO-1610) (CRO-1620) | | (cx0.1720) (cRo0.1710) (cRO.1480) (cR0.2200) TTT (ROIS) Tago O08Amendment Aggregated Contributions from Individuals ase tee te See Optional form used to report NC Contributions From Individuals of $50 or less * Committee Full Name (and Fund if applicable) Number ed Van Dyk Election Committee 3. Contributor Information count ‘i iKind cate [nem Ascomat | Form of Payment Sed [SOR ay |e Amownt | ha fy Tena CHKOTS | Cash _ 9716109 $30.00 iE nil enors | can Toe fen ae - TE | Remove i = fe) aaaa [ra s [Remove (ie [eee In [Eres | | o + el q a ; s O a eee = 7 He s a | [Remove g rel [aa $ Remove Hate : - [Remove | = _| : oy sas : (_[Remave __ 7d Het se O Add s | Remove - O_[aa 5 [ET Remove = (Tae | ad T [Remove - s [aaa 5 FE [Renae Z = —| O Aad s CP Remove |__| (Tae CL [Remove _ ee | - ‘Ads Hy Ties -, 4. Total only this Page 330.00 5. Total of ALL CRO-1205 Pages $30.00 (This tne must be on tne $ of Detaled Summary Page CRO-1100) CRO-1205 TNE State Board of Eesions pao