Elam,Edwin_2022-3rd-qtr'Amendment
Disclosure Report Cover ❑ Yes ErNo
Use this form for general report and committee information, must be signed and submitted along with other detailed forms.
Do not USC this form to a rdute information.
L Committee Information
a. Full Name
c. ID Number
�f�W.-t IAM �J GV4�JJlJ VC�
A-T#,K3Z�
h. Mailing Address (include City, State and Zip Code)
d. Date Fled
/ CTV L it A—) Flt 2%J A `f d / Z j
2uZZ
G
!��`4 Cj'� x+- i C- Zo f %j
y
e. Phon Numdler - ----.- -
7c Y- y 7��- -G S- '
2. Report Year
3. Period Start Date mould vyy)
4. Period &nd Date (mm(ddtyy)
S..Treasurer Full Name
°YLo
ZZ
o ZZ 2_
EDW'*.d F �M
6. Type of Committe (Ch" k One) -
9. Type ofLiorf"(check
only one type of rep
front one category] _
M-F.mdidaie Campaign ❑ Pan'N
:Municipal
State/County
Referendum
❑ PAC ❑ Referendum
❑ Organizational
❑ Organizational
❑ organizational
❑ Independent Expenditure ❑ Joint Fundraiser
❑ Thirty-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Pund
❑ Pre-primary
❑ First
❑ Final
❑ Preelection
❑ Pre-mnoff
❑ /Second
Lb--/ Third
❑ Supplemental Final
❑ Annual
. Type of Fund liftrpplfroble, check one)
❑ Bcoster 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
-
S. Number of Fundraisers this Report
❑ Special
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
2S A)A, I t31JA( A J
. Purpose
-
c. Account Code
b. Purpose
Nov 0 2 ?a??-
c. Account Code
_
GfC E 2 2 -
R E C F I V E ''- `
d. Period
it. Begin Balance
d. Period Begin Balance
$
$ z. (YC
CERTIFICATION
I certify that the Committee or Fund is in compliance with all a licable provisi f Article 22A, 22B & 22D -22M of Chapter 163
of the NC General Statutes and that no funds are co g ed wi rohibit oth r non -disclosed funds. I further certify that this
report is complete, true and correct and that I h een.traified by the to B d of Elections.
E-4ji , EI/i Z(3Z2
Printed Name of Signer Signature of Appointed Treasurer Date
FOR OFFICE USE ONLY
Date Received: Employee: Delivery Method
❑ Normal Mail
Date Postmarked: Employee: ❑ Registered Mail
❑ Hand Delivered
Date Scanned: Employee: ❑ Electronically Filed
Date Data Entered: Employee: [3 Signer has not receivedmandatory trainin
Please Note: This form cannot be used to amend comaduee 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.
CRU -1000 NC State Board of Elections August 2008
Amendment
Detailed Summary ❑ EJIN.
Use this form to summarize all di,,cIoxurr nrnonine forms and to total monetary information
1. Committee Full Name (and Fund if applicable)
,7
2. Type of Report _
3. Ill Number
...222.2 ..............-_-.
M YJ
Start of Election Cycle: January 1,
Total this
Reporting Period
Total this
Election Cycle
4) Cash on Hand at Start
5
$
RECEIPTS
5) Aggregated Contributions from Individuals (CRO -1205)
6) Contributions from Individuals (CRO -1210)
7) Contributions from Political Party Committees (CR04220)
_ 2222
8) Contributions from Other Political Committees (CRO -1270)
9) Loan Proceeds (CRO -1410)
10) Refunds/Reimbursements to the Committee (CRO -1240)
11) Other Receipt Sources
I la) Interest on Bank Accounts (CRO -1250)
11b) Contributions from Not -For -Profit Organizations (CRO -1250)
l le) Outside Sources of Income (CRO -1250)
I Id) Legal Expense Fund - Other Sources (CRO -1270)
Ile) Exempt Purchase Price Sales (CRO -1265)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
12)TOTAL RECEIP'IS(Addlines 5,6, 7, 8, 9, 10,11 a, l l b. l l c, l ld and l le)
$
$
EXPENDITURES
13) Disbursements
13b) Contributions to Candidates/Political Committees (CRO -1310)
.—_ --. ..2...2..2....,2
13a) Operating Expenditures (CR0-1310)7,7
13c) Coordinated Party Expenditures (CRO -1310)
14) Aggregated Non -Media Expenditures ((ao-1315)
15) Loan Repayments - (CRO -1420) $
16) Refunds/Reinnbursements from the Committee (CRO -1.720) $
17) In -Kind Contributions (CRO -1510) $
$
$
$
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ --CJ—
$
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18 $ 5—
ADDITIONAL
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees (CRO -1330)
1) Outstanding Loans ('incl. ones from other campaigns) (CRO -1430)
22) Debts and Obligations owed by the Committee (CRO -1610)
Debts and Obligations owed to the Committee (CRO -1620)
4) Account Transfers Within the Committee (CRO -1720)
25) Administrative Support (CRO -1710)'
6) Forgiven Loans (CRO -1440)
27) 48 -Hour Notice Reports Sum KTO-2220)
8) Contributions to be Refunded (CRO -121S)
$
VT 2
$ Q
$
$
$
$
$
$
$
CRO -1100 NC State Board of Elections August 2008