Dotson,David_2023-Org-reportAmendment
Disclosure Report Cover 0 Yes [::] No
Use this form for general report and committee information, must be signed and submitted along with other detailed forms.
tn
Do not w;e this form to iincinte, information_
1. Committee Information
a. Full Name
c. ID Number
M/X/17�r 7-29
U 1w"
d. Date Filed
b. Mailing Address (include City, State and Zip Code)
e. Phone Number
2. Report Year 3. Period Start Date (mm/dd/yy) 4. Period End Date (mm/dd/yy)- .5. Treasurer Full Name ---------- ---------- --- ---
- ------------ - ----- ---------- --------------
711z, -9
�/ 2 4-, 2") 0 , Lle
zt 07
(check only one �ype o
6. Type of Committee (Check One) 9. Type of Rep f reportfrom one category)
--- -------
Candidate Campaign 0 Party Municipal State/County Referendum
❑ PAC 0 Referendum Organizational ❑ Organizational 0 Organizational
❑ Independent Expenditure [] Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre -referendum
❑ Legal Expense Fund ❑ Pre-primary First ❑ Final
0 Pre-election 0 Second 0 Supplemental Final
7. Type of Fund (if applicable, check one) ❑ Pre -runoff ❑ Third 0 Annual
0 Booster Fund Semi-annual ❑ Fourth 0 Special
0 Building Fund ❑ Mid Year Semi-annual
0 Year End 0 Mid Year 10. Special Report Name
0 Other: 0 Final 0 Year End - ----------- - ---------
Number of Fundraisers this Report ❑ Special [] Final
El Special
11. Account Information
11. Account Information
Financial Institution Full Name
a. Financial Institution Full Name
Purpose-
c. Account Code
b. Purpose
C.A �t Code
00009
I 7eo,;; 741 leo,
d. Period Begin Balance
riod Begin Balance
U L 4U41W
$ 4 oa 4 v
$
CER TIFICMIodl union o. o, of Elections
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 I Elections.
atheNC 7eB 7d Vof
Ile,
Printed Name of Signer Signature of Appointed Treasurer Da(e
FOR OFFICE USE ONLY
Date Received: Employee: Delivery Method
0 Normal Mail
Date Postmarked: Employee: [] Registered Mail
0 Hand Delivered
Date Scanned: Employee: 0 Electronically Filed
0 Signer has not received
Date Data Entered: Employee: 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.
gust u
NU State board of tiections Au_/UM
CRO 1000 L_
Detailed Summar Amendment
y ❑ Yes ❑
Use this form to summarize all disclosure reoortinQ forms and to total monetary information
1. Committee Full Name (and Fund if applicable)
2. Type of Report
3. ID Number
11� &1111ZF
I JM -3�
Cycle: Januar 1, _ � � _s
Start of Election C Y y
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 Party Committees
8) Contributions from Other Political Committees
9) Loan Proceeds
10) Refunds/Reimbursements to the Committee
11) Other Receipt Sources
I la) Interest on Bank Accounts
11 b) Contributions from Not -For -Profit Organizations
I1c) Outside Sources of Income
11d) Legal Expense Fund - Other Sources
11e) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
$
$ 00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
12) TOTAL RECEIPTS ( Add lines 5, 6, 7, 8, 9, 10,11 a, l l b, l 1 c, l 1 d and 11 e)
$
0
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)
$
$
$
$
$
$
$
$
$
$
- -�-�
$
$
UL 10 2023
8) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$
42 4:52
$
[19)Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$
o , w,j,
Ual LIUUt
$
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees
1) Outstanding Loans (incl. ones from other campaigns)
2) Debts and Obligations owed by the Committee
3) Debts and Obligations owed to the Committee
4) Account Transfers Within the Committee
5) Administrative Support
6) Forgiven Loans
7) 48 -Hour Notice Reports Sum
8) Contributions to be Refunded
(CRO -1330)
(CRO -1430)
(CRO -1610)
(CRO -1620)
(CRO -1720)
(CRO -1710)
(CRO -1440)
(CRO -2220)
(CRO -1215)
$
$
$
$
$
-- - - -
$
$
$
$
$
$
$
$
CRO -1100 NC State Board of Elections August luuti
Amendment
Contributions from Individuals Pg Of 1:3 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)
-------------- - - --- - -------------------- --------------
70� t%j
2. ID Number
-2,
3. Contributor Information 0 Add 0 Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip) ---- - - -----
11"'e11111�
�� 2- IVC -27� <t
b. Job Title/Profession
d. Comments
c. Employer's Name/Specific Field
e. Election Sum to Date
$
Prior
g. Account Code
h. Form of Payment
i. In -Kind Description
j. Date (mm/dd/yyyy)
k. Amount
0
,Iko;P,A 100V& ;6F
v /� � Z3
$
0
$
3. Contributor Information 0 Add 0 Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
c. Employer's Name/Specific Field
e. Election Sum to Date
Prior
g. Account Code
h. Form of Payment
i. In -Kind Description
j. Date (mxn/dd/yyyy)
k. Amount
$
1:1
0
$
0
$
---- - -- --- --- -- --
3. Contributor Information 0 Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
-
R V
V!U L 10 2023
Union Co. Board of Elections
b. Job Title/Profession
d. Comments
c. Employer's Name/Specific Field
e. Election Sum to Date
$
Prior
0
g. Account Code
h. Form of Payment
-j
i. In -Kind Description
j. Date (mnVdd/yyyy)
k. Amount
$
0
$
0
$
4. Total only this Page $
5. Total of ALL CRO -1210 Pages $
(This line must be on line 6 of Detailed Summary Page CRO -1100)
CRO -1210
NC State Board of Elections
April 2007
fAmendment
In -Kind Contributions P9 of ❑ Yes p No 3
Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund.
'r IF .6 /% 1 1- • 1- Ir lv7.11 1 1 11 P -r I
use I L 13 ii to-r%Jnd �_Ionlri buLions were or w1li De relull(IeLl WIL11111 Uays.
. ..... ......... fiW
....... ..... . . .
igittee Full"" wid Fund i -18 ....... .........
Ulu me
oel - ---------------- 46"
0/
2.
3. C tributor Information El Add El Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
1). Type of Contributor
❑ Individual
❑ Candidate
❑ Party
❑ PAC
❑ Referendum
❑ Other Receipt Source
c. Comments
•• •
1q1140VKd4r lur 201:51!! 1
d. Election Sum to Date
$
e. Description
L Date (mm/dd/yyyy)
g. Fair Market Amount
3. Contributor fil, El Add 0 Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Type of Contributor
❑ Individual
Candidate
Party
❑ PAC
El Referendum
❑ Other Receipt Source
c. Comments
d. Election Sum to Date
$
e. Description
L Date (mm/dd/yyyy)
g. Fair Market Amount
$
.. . . . . . . . . . . ...... .... . . ........... .... ..
3. Co , ntribWor Information 0 Add 0 Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Type of Contributor
❑ Individual
0 Candidate
[:] Party
0 PAC
❑ Referendum
El Other Receipt Source
c. Comments
d. Election Sum to Date
$
e. Description
f. Date (mm/dd/yyyy)
g. Fair Market Amount
4. Total only this Page "P,
................ ..............
5. Total of ALI, CRO -1510 Pages ... .......... . ....
............
r n4 ,oar
$
............... . ...........................
(This line must be on line 17 of Detailed Summary Pd CRO -1100)
CRO -1510 NC State Board of Elections December 200-y