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Bention,Jimmy_2022-3rd-qtrAmendment Disclosure Report Cover ❑ Yes ® Nm Use this form for general report and committee information, must be signed and submitted along with other detailed forms. nn not ovp thic fnrrn to nndate infnrtnation 1. Committee Information a. Full Name c. ID Number Committee to Elect Rev. Bention, Sr. b. Mailing Address (include City, State and Zip Code) it. Date Filed 302 Tucker Street 11/01/2022 Monroe, NC 28110 e. Phone Number 704-572-0879 2. Report Year 3. Period Start Date (mm/dd/yy) 4• Period End Date 5. Treasurer Full Name (mm/dd/yy) Latoya L. Bention 02 : 0701 _0_ _9 _ 10 9 _0_2 6. Type of Committee Check One 9. Type of Report eck only one type ofreport om one category) ® Candidate Campaign ❑ Party Municipal State/County Referendum ❑ Organizational ❑ Organizational ❑ Organizational ❑ PAC ❑ Referendum Independent ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Expenditure ❑ Legal Expense Fond ❑ ❑ Pre -Primary Pre-election ❑ First ❑ Second ❑ Final ❑ Supplemental Final 7. Type of Fund (ifapplicable, check one) ❑ "Booster Fund" ❑ Building Fund ❑ Pre-nmoR ® Third ❑ Annual Semi-annual ❑ Fourth ❑ Special ❑ Mid Year Semi-annual 10. Special Report Name ❑ Other ❑ Year End ❑ Mid Year ❑ Final ❑ special ❑ Year End ❑ Final ❑ Special 8. Number of Fundraisers this Report 11. Account Information 11. Account Information a. Financial Institution Full Name a. Financial Institution Full Name Wells Fargo b. Purpose c. Account Code b. Purpose c. Account Code Election 104 UNION COUNT`r Committee ;AMPAIGN FINANCE d. Period Begin Balance Donations d. Period Begin Balance OCT 31 2022 $ 2,568.87 $ CERTIFICATION HLUENED 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. Latoya L. Bention 4. 4. �rw� 10/30/22 Printed Name of Signer Signature of Appointed Treasurer Date FOR OFFICE USE ONLY Delivery Method Date Received: O Employee: ❑ Normal Mail Registered Mail Date Postmarked: Employee: Hand Delivered Electronically Filed Date Scanned: Employee: ❑ Signer has not received 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-210OA-E) to make committee changes. ( RO-1000 NC State Board of Elections August 2008 Amendment Detailed Summary ❑ yes ® No tme thi. f— to dicrincnre r,rortino fnrms and to total monetary information. 1. Committee Full Name and Fund H applicable) 2. Type of Report 3. ID Number Committee to Elect Rev. Bention, Sr. Third Quarter Report Start of Election Cycle: January 1, 2022 Total this Reporting Period Total this Election Cycle 4) Cash on Hand at Start RECEIPTS " " 5) Aggregated Contributions from Individuals 6) Contributions from Individuals 7) Contributions from Political Parry Committees 8) Contributions from Other Political Committees 9) Loan Proceeds 10) Refunds/Reimbursements To the Committee 11) Other Receipt Sources Ila) Interest on Bank Accounts lib) Contributions from Not -for -Profit Organizations Ile) Outside Sources of Income 11d) Legal Expense Fund — Other Sources 11 e) Exempt Purchase Price Sales (CRO -1205) (CRO -1210) (CRO -1110) (CRO -1230) (CRO -/410) (CRO -1140) (CRO -1250) (CRO -1150) (CRO -1150) (CRO -1270) (CRO -1265) $ $ 2,568.87 20 $ $ 0 380 $ 750 $ 3390 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12) TOTAL RECEIPTS (Add lines s.6. 7. S. 9. 10. Ila, Itb, Ile. lldandlie) 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) RefundslRelmbursements From the Committee (CRO -1320) 17) In -Kind Contributions (CRO -1510) $ 770 $ 3770 - $ 2,735.91 $ 3,140.45 $ 300 $ 300 $ 0 $ $ 26.59 $ $ $ $ $ $ $ 18) TOTAL EXPENDITURES (Add lines I3a, 13b, 13c.14. 15. 16 and 17) $ 3,035.91 $ 3,467.04 19) Cash on Hand at End e idd lines 4 and 12 together, then subtract line 18) NAL INFORMATI 20) .\on-Monetar) Gifts Gi.en 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 Com COUNTY (CRO -1720) 25) Administrative Support CAMPAIGN FINANCE (CRO -1710) 26) Forgiven Loans OCT 31 2022 (CRO -1440) 27) 48 -Hour Notice Reports Sum (CRO -2220) 28) Contributions to be Refunded RECEIVED (CRO -1215) $ $ 302.96 $ 302.96 $ $ $ $ $ $ $ $ $ $ $ $ CRO -1100 NC State Board of Elections - - Amendment Aggregated Contributions from Individuals Page or I ❑ Yes ® No Ontinnal fhm used to report NC Contributions From Individuals of $50 or less 1. Committee Full Name and Fund if applicable) 2. ID Number Committee to Elect Rev. Bention. Sr. 3. Contributor Informadon a. Amend b. Accountd. Code c. Form of Payment In -Kind Dmri tion(mm/dd/yy e. Date f. Amount ❑ Add 104 Cash N/A 10/10/2022 $ 20.00 ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ F-1 .. ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ I Remove ❑ 1 Add N GOUNiY - $ ❑ Remove ❑ Add Gi�tv1PA1' $ ❑ Remove ❑ $ ❑ ❑ $ ❑ URemove ❑ $ ❑ ❑ $ ❑ 4. Total only this Page $ 20.00 5. Total of ALL CRO -1205 Pages $ 20.00 (This line must beon line S of Detailed Summary Page CRO -1100) CRO -1205 ( State Board of Flections April 2007 Amendment Contributions from Individuals Pg I of z ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Full Name (and Fund if applicable) 2. ID Number Committee to Elect Rev. Bention. Sr. 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, &zip) b. Job Title/Profession d. Comments General Contractor Mark Brody 5315 S Rocky River Road Monroe, NC 28112-8055 (704) 965-6585 c. Employer's Name/Specific Field Self e. Election Sum to Date $ 0 L Prior & Amount Code It. Form of Payment i. In -Kind Description j. Date (mmlddlyyyy) k Amount ❑ 104 CreditCard N/A 07/15/2022 $ 250 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Banker / Pastor William Grey 3609 Savannah Way Monroe, NC 28110 a Employer's Name/Specific Field e. Election Sum to Date $ 0 L Prior g. Account Code h. Form of Payment i. to -Kind Description J. Date (mmtdd/yyyy) It. Amount ❑ 104 Check N/A 08/27/2022 $ 200 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) TY b. Job Tine/Profession d. Comments Retired Patrick Ham -son CAMPAIGN FINANCE 2001 Belleforest Ct Waxhaw, NC 28173-7381 OCT 31 2022 RECEIVED c. Employer's Name/Specific Field N/A a Election Sum to Date $ 0 L Prior g. Account Code It. Form of Payment L In-IGnd Description j. Date (mmidd/yyyy) Is. Amount ❑ 104 Check N/A 09/17/2022 $ 100 ❑ $ 4. Total only this Page 5 550 5. Total of ALL CRO -1210 Pages 5 750 (This line xuw be on line 6 of Demdkd Summary Page CRO -1100) CRO -1210 Vc Slate Board of Elections April LW 1 Amendment Contributions from Individuals Pg z of z ❑ Yes ® No Use this forth to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Full Name (and Fund if applicable) 2. ED Number Committee to Elect Rev. Bention, Sr. 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Transportation Director Scott Denton 2817 Pulaski Drive Monroe, NC 28110-7818 (919) 495-0251 c. Employer's Name/Specific Field UCPS a Election Sum to Date $ 0 I, Prior g. Account Code It. Form of Payment 1. In -Kind Description j. Date (mmtdd/yyyy) k Amount ❑ 104 CreditCard N/A 10/06/2022 $ 100 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Tine/Profession d. Comments Engineer Allison Powers 1322 Churchill Downs Dr Waxhaw, NC 28173-6585 (440) 796-7315 c. Employer's Name/Specific Field Unemployed e. Election Sum to Date $ 0 f. Prior g. Amount Code It. Form of Payment I. In -Kind Description J. Date (mm/dd/yyyy) L Amount ❑ 104 CreditCard N/A 10/19/2022 $ 100 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name. ?tailing Address & Phone (include city, stgta, It. Job Title/Profession d. Comments N FIN :��MPA1G OCj 3 t 2022 c Employer's Name/Specific Field a Election Sum to Date f. Prior g. Amount Code It. Form of Payment 1. In -Kind Description j. Date (mm/dd/yyyy) L Amount ❑ $ 4. Total only this Page S 200 5. Total of ALL CRO -1210 Pages S 750 (This line must be on line 6 of Detailed Summary Page CRO -1 100) CRO -1210 NC State Board of Elections April 2007 Amendment Disbursements Pg , of 3 ❑ vex ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated art ex enditures. 1. Committee FuR Name and Fund V a ficable 2. ED Number Committee to Elect Rev. Bention. Sr. 3. Ty pe of DM_ ement (Please use separate CRO -1310 arms or each o Disbursement ® Operating [xpense+ ❑ Contributions to Candidata PoGucal Committu•> ❑ ('oordinat0.d Pane LxpcndaurLc 4. Payee Information I I Add El Remove a. Full Name• Mailing Address & Phone include city. stat &ZI b. Coordinated Committee Name d. Comments Campaignpartners.com PO Box 118 Still River, MA 01467 617-500-7251 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 299 L Account Code g. Form of Payment Th. Purpose Code L Date (nualddlyyyy) j. Amount it. Required Remarks 104 CreditCard O 07/08/2022 $49 Monthly website fee 104 CreditCard O 08/08/2022 $49 Monthly website fee 4. Payee Information I I Add El Remove s. Full Name, Mailing Address & Phone include city, stat & ri It. Coordinated Committee Name d. Comments Campaignparmers.com PO Box 118 SUIT River, MA 01467 617-500-7251 c. level Registered (Specify) ❑ Federal ® County: ❑ state ❑ Municipality: e. Election Sum to Date $ L Account Code g. Form of Payment h. Purpose Code L Date (mm/dd/yyyy) j. Amount k. Required Remarks 104 CreditCard O 09/08/2022 $49 Monthly website fee 104 CreditCard O 10/11/2022 $49 Monthly website fee 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, stat & zip) b. Coordinated Committee Name d. Comments TST*National Coney Isl UNiUfJ GOUT 111 Detroit, Ml 48242 CAMPAIGN FINAN' - 0 C T 31 2022 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ o L Account Code I g. Form of Paym L Date (n m/dd/yyyy) J. Amount it. Required Remarks 104 CreditCard O 07/19/2022 $55.40 Refreshments 5. Total only this Pae $ 251.40 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summaq Page CRO -1100 if operating Expenses) $ 2,735.91 (This line goes in line 136 of Derailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm) (This line goes in line 13c of Derailed Summary Page CRO -1100 if Coordinated Party Expenditures) 7. Purpose Codes(List detailed expendimm code in above A* - Media B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Parry H* - Holding Public Office Expenses 1 - Postage J - Penalties K* -Office Expenses Q* - Donation to Legal Expense Fund O* - Other * Codes require detailed explanation in required remarks field k CRO -1310 NC State Board of Elections Deeemoer _uw, Amendment Disbursements Pg z of 3 ❑ vi- ® No Use this form to report expenditures from the committee for: operating expenses, contributions to candidate/political committees and coordinated art ex enditures. 1. Committee Foo Name and Fund If applicable) 2. ED Number Committee to Elect Rev. Bention. Sr. 3. Type of Disbursement lease e seowage CRO -1310 form for each tyre of Dishursentent ® Operating Lxpease.. ('ontrihuuons to (Candidan5 Political Convnitt c� ❑ Coordinatxd Party Fxprnditures 4. Payee Information I I Add ❑ Remove a. Full Name. Mailing Address & Phone include city, stat & zip) b. Coordinated Committee Name d. Comments Toolbox Studios 10123 Broadway San Antonio, TX 78127 210-225-8269 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 0 E Account Code I g. Form of Payment h. Purpose Code L Doe (mm/ddlyyyy) J. Amount it. Required Remarks 104 Check B 07/21/2022 $2,450.56 Ward Signs $ 4. Payee Information 1 11Add Remove a. Full Name, Mailing Address & Phone include city. stat & zip) b. Coordinated Committee Name d. Comments Wells Fargo 420 Montgomery Street San Francisco, CA 94104 e. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 0 L Account Code g. Form of Payment h. Purpose Code L Date (mm/dd/yyyy) J. Amount k. Required Remarks 104 Withdraw[ O 08/23/2022 $10 Monthly Service fee 104 Withdrawl O 09/26/2022 $10 Monthly Service fee 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, statINTY b. Coordinated Committee Name d. Comments �kh.1PAIGN FINANCE OCT 31 2022 RECEIVED c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ L Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) J. Amount it. Required Remarks $ $ 5. Total only this Pae $ 2,470.56 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Derailed Summary Page CRO -1 /00 if Operating Expenses) (This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to Candidates/Polifical Comm) (This line goes in line 13c of Detailed Summary Page CRO4100 if Coordinated Party Expenditures) $ 2,735.91 7. Purpose Codes(List detailed expenditure code in above A* - Media B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* - Other "Codes require detailed explanation in required remarks field k) CRO -1310 NC State Board of Elections December muv Amendment Disbursements Pg of 3 ❑ Yes ® No Use this forth to report expenditures from the committee for: operating expenses, contributions to candidate/political rnmmitteec and rnnMinnted nartv exne.nditurec. 1. Committee Fall Name and Fund if a iicable 2.1 Number Committee to Elect Rev. Bention. Sr. 3. Type of Disbursement IPWw use separate CRO -1310 foFna for each type o Disbursement ® Operating Expcox, ❑ (-ontrihutions to (Cendid'atc Political ( onnnitt c> [_] Coordinated Party Expenditures 4. Payee Information I I Add Remove a. Fug Name, Mailing Address & Phone include city. state- & b. Coordinated Committee Name d. Comments Online Platform for accepting donations https://stripe.com/ 185 Berry St #550 San Francisco, CA 94107 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 49.54 f. Account Code & Form of Payment It. Purpose Code L Date (mm/dd/yyyy) J. Amount k. Required Remarks 104 Bank Draf O 07/15/2022 $7.55 Stripe processing fee 104 Bank Draft O 10/06/2022 $3.20 Stripe roc essing fee 4. Payee Information rl dd El Remove a. Full Name, Mailing Address & Phone include city, stat &a b. Coordinated Committee Name d. Comments https://stripe.com/ 185 Berry St #550 San Francisco, CA 94107 c. Level Registered (Specify) ❑ Federal ® county ❑ State ❑ Municipality: e. Election Sum to Date $ 60.29 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k- Required Remarks 104 Bank Draft O 10/19/2022 $3.20 Stripe processing fee S 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, stat .t,IP/UGN FINAN� _ OCT 31 2022 RECEIVED b. Coordinated Committee Name d. Comments c. Level Registered (Specify) ❑ Fedeml ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ f. Account Code g. Form of Payment h. Purpose Code L Date (mm/dd/yyyy) j. Amount it. Required Remarks 5. Total only this Pae $ 13.95 6. Total of ALL CRO -1310 Pages (This line goes in line 13a oJ'Detailed Summary Page CRO -1100 if Operating Expenses) $ 2,735.91 (This line goes in line 13h of Detailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Parry Expenditures) 7. Purpose Codes(List detailed expenditure code in h. above A* - Media B* - Printing C* - Fundraising D - To Another Candidate E - Salaric, F* - Equipment G - Political Party H* - Holding Public Office Expenses 1 - Postaec J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* - Other * Codes require detailed explanation in required remarks field (k) CRO -1310 NC State Board of Elections Det ember 2009 Amendment Disbursements Pg It of if ❑ ves ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political 1. Committee Full Name and Fund if applicable) 2. ID Number Committee to Elect Rev. Bention, Sr. 3. Type of Disbursement lease use separate CRO -1310 forms or each e o Disbursement [—]Operating Expenses ® Contributions to ('andidateSPolitical Committees ❑ Coordinated Party Expenditures 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, slat & zip) b. Coordinated Committee Name d. Comments Union County NAACP P.O. Box 3264 Wingate, NC 28174 704 324 0031 c. Level Registered (Specify) ❑ Federal ® County ❑ State ❑ Municipality: c Election Sum to Date $ 0 E Account Code g. Form of Payment Is. Purpose Code L Date (mm/dd/yyyy) j. Amount k. Required Remarks 104 Check C 10/04/2022 $300 2022 Annual Banquet $ 4. Payee Information I I Add Remove a. Full Name, Mailing Address & Phone include citv. slat & A It. Coordinated Committee Name d. Comments a Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ L Account Code g. Form of Payment h. Purpose Code L Date (mm/dd/yyyy) j. Amount k. Required Remarks $ $ 4. Payee Information I I Add ❑ Remove a. Full Name, Mailing Address & Phone include city, stat & A1011 It. Coordinated Committee Name d. Comments CAMPAIGN FINANCE OCT 31 2022 RECEIVED e. Level Registered(Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ f. Account Code g. Form of Payment I Is. Purpose Code L Date (mm/dd/yyyy) j. Amount it. Required Remarks 5. Total only this Pae $ 300 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) $ 300 (This line goes in line lab of Detailed Summary Page CRO -1100 ifConhlb to CandidatestPolitical Comm) (This line goes in line 13e of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) 7. Purpose Codes(List detailed expenditure cute in above A* - Media B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment C - Political Party H* - Holding Public Office Expenses 1 - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* - Other * Codes require detailed explanation in required remarks field (k) CRO -1310 NC State Board of Elections December 2009