Cohn,David_2023_Pre-electionDisclosure Report Cover o 'dement ❑ 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
. Full Name
c. m Number
�l'(�t
14 c) e-
r o�
t ing Address (include City, State and Zip Code)
d. Date Filed
�)(ci �lilLI
to to 't z
e. Phont Numbef
Report Year
3. Date (mm✓daiyy)4. PeripdEnd Date mmrdd(yy)
5. Treasurer Full Name
z��13
7eriStu
�o z 2
> U
6. Type of Committee (Ch&k One)
Type 16f Re (check
only off -type
of reportfr6m
one caregory)
Municipal
State/County
Referendum
❑ Candidate Campaign ❑ Party
❑ PAC ❑ Referendum
❑ Organizational
❑ Organizational
❑ Organizational
❑ Independent Expenditure ❑ Joint Fundraiser
❑ 7hiny-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑ Pre-primary
❑ First
❑ Final
Qpre-election
❑ Pre -runoff
❑ Second
❑ Third
❑ Supplemental Final
❑ Annual
. Type Of Fnnd (if applicable. check one)
❑ Booster Fund
Semi-annual
❑ Fourth
❑ Special
❑ Building Fund
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
10. Special Report Name
❑ other:
❑ Final
❑ Special
❑ Year End
❑ Final
8. Number of Fundraisers this Report
❑ Special
1. Account Information
11. Account Information
. Financial Institution Full Name
a. Financial Institution Full Name
_—
r • �I G -'L-
. Purpose
n Account Code
_ Purpose u�lON-CollN-e�
c. Account Code
CAMPAIGN FINANCE
d. Period Been Balance
it. Period Begin Balance
�flUe'7�
OCT 30 2023
$ i3gl. Z
g
CERTIFICATION
1 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, w11e and correct and that 1 have been trained by the NC StateBoard of Elections.
Printed Name of Signer Signature o pp9mied Treasurer Line
OR OFFICE USE ONLY
,
'^ ,
Date Received: 1q -V � Employee: Delivery Method
N
t ❑ormal Mail
'
Date Postmarked: Employee: Registered Mail
Hand Delivered
Date Scanned: Oi✓ Employee: Electronically Fled
Date Data Entered: Em to ee: [3 Signer has not received
P y mandatory ununin
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-21o0A-E) to make committee changes.
CRO -1000 NC State Board of Elections August 2008
Amendment
Detailed Summary ❑ Yes ❑ No
Use this form to summarize all disclosure re rtin forms and to total monetary information
1. Committee Full Name _ app_ _
t�•� L dna a�
ype or Report
V; e--
_ r
Start of Election Cycle: January 1,2a 0
--Z—ReportingPeriod
Total this
Total this
Election Cycle
4) Cash on Hand at Start
I $ Z
$
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)
0) Refunds/Reimbursements to the Committee (CRO -1240)
11) Other Receipt Sources
Ila) Interest on Bank Accounts (CRO -1250)
I lb) Contributions from Not -For -Profit Organizations (CRO -1250)
I1c) Outside Sources of Income (CRO -1250)
I Id) Legal Expense Fund -Other Sources (CRO -1270)
Ile) Exempt Purchase Price Sales (CRO -1265)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10.1 la,1 Ib,I Ic,I Id and l le)
$
$
EXPENDYWRES
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)
$ ��
$
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$ g '�
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees (CRO -1330) $
1) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) $
Debts and Obligations owed by the Committee (CRO -1610) $
Debts and Obligations owed to thAJNTY (CRO -1620) $
- - - CAMPAIGN FlnirnN G
Account Transfers Within the Committee (CRO -1720) $
Administrative Support �$ (Ce0-1710) $
18)
Forgiven Loans R F (CRO [440)
— RF
48 -Hoar Notice Reports Sum (CRO -2220)
$
$
Contributions to be Refunded (CRO -1215)
$
CR04100 NC State Board of Elections A11,1_IN 'noa
Amendment
Disbursements Pg _ of _ ❑ Yes ❑ No
Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political
committees and coordinated arty ex znditures
1. Fell Name (ami lhmd
2. ID Number
�Ao• COttt FV5r t--
3 T of Disbursement (Please use separate CRO -1310 forms for each tune of Disbursement.)
6Operm lnc Expense, 11 to Candidates/Pulitiidl C'unnniucc. ElCoordinated Pan)' Expenditures
4. Payee Information ❑ Add ❑ Remove
a. Full Name. Mailing Address & Phone
b. Coordinated Committee Name
d. Comments
include city, stale, & zip)
C- C, L
c. Level Registered (Specify)
❑ Federal ❑ Co :
❑ Shue Municipality:
e. Election Stun to bete
. Account Code
g. of Payment
Ilk Purpose Codei.
Date (uunlddl yyy)
J• Amount
it. Required Remarks
`Form
-
- ([7 to z 3
$ . G o
' , k P c t
is
4. Payee Information 0 Add Ll Remove
. Full Name, Mailing Address & Phone
Is Coordinated Committee Name
d. Comments
(include city. state, & zip)
(• b �+^ ,�^
(—v
c. Level Registered (Specify)
❑ Fecicnd ❑ Co ty:
E3stateMunicipality:
e. Election Sam to Dale
$
f. Account Code
g. Form of Payment
L e 11
h. Purpose Code _
L Date (mm/ )
J. Amount
it. Required rRemarks
O V
p
r
$ o
Mrd
4. Payee Information A d Remove
a. Full Name, Mailing Address & Phone
b. Coordinated Committee Name
d. Comments
(include city, state, & zip)
CAMPAIGN FINANCE
OCT 3 O 20LJ
c. Level Registered (Specify)
E3—Federal unty: Co
❑ State ❑ Municipality:
e. Election Sam to Date
LJ
$
f. Account Code
g.Fora1IotPWyj&nt
ILPurposeCode
1,Date (mm/ddlyyyy)
'. Amount
k Required Remarks
Is
1
5. Total only this Page
$
6. Total of ALL CRO -1310 Pages
(This line goes in line l3a of Detailed .Summary Page CRO -1100 if Operating Expenses)
n ,.
$ 7N
(((///
(This line goes in line lab of Delailed .Summary Page CRO -1100 if C'untrib to C'andidotes/Political Comm)
('()is line nes in line 13c of Detailed Summary Page CRO-110(li Caardinnted Party Ex enditures)
7. Purpose Codes (List detailed expenditure code in (h.) above)
A* - Media B* - Printing C* - Fundraising D - To Another Candidate
E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Ex]Fund
1 - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expen
O* Other
* Codes reimire detailed emilaintion In reunited remarks field W
CRD -1.110 NC Slate Board of Elections December 2009