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Gay,Dennis_2021-Final-reportAmendment Disclosure Report Cover ❑ Yes ® 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 a. Full Name c. ID Number Committee To Elect Dennis Gay OJMO.I I b. Malang Address (include City, State and Zip Code)d. Date Filed 4705 Pioneer Lane Indian Trail, NC 28079 DEC 16 2021 12/16/2021 e. Ptmae Number (252) 723-1525 RECEIVED 2. Report Year 3. Period Start Date (mm/dd/yy) 4. Period End Date Imm/dd/ 5. Treasurer Full Name 2021 10/19/2021 12/162021 Randall Haron Gay 6. Type of Committee Check One 9. Type of Report check only one t&ype of report om one category) ® Candidate Campaign ❑ Party Municipal State/County Referendum ❑ PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational Independent ❑ ❑ Expenditure Joint Fundraiser ❑ Thirty-five day Quarterly E]Pre-referendum ❑ Legal Expense Fund ❑ ❑ Pre-primary Preelection ❑ First ❑ Second ❑ Final ❑ Supplemental Final 7. Type of Fund (Ifopplicable, check one) ❑ "Booster Fund" ❑ Building Fund ❑ Pre -runoff ❑ Third ❑ Annual Semi-annual ❑ Fourth ❑ Special ❑ Mid Year Semi-annual ® Other ® Year End ❑ Mid Year 10. Special Report Name ® ❑ 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 American Bank b. Purpose c. Account Code Is. Purpose c. Account Code Campaign 01 expenses it. Period Begin Balance d. Period Begin Balance S 1210.00 $ CERTIFICATION I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B, & 220-22M 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 1 have been trained Randall Haron Gay by the NC to Board o Flee ' ns. Printed Name of Signer Signature of AppoiailliTeasurer Date FOR OFFICE USE ONLY Date Received: Employee: Delivery MethoElmd Noral Mail Date Postmarked: Employee: Registered Mail Hand Delivered Date Scanned: Employee: Electronically Filed ❑ 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. CRO -1000 NC State Board of Elections August 2008 Amendment Detailed Summary ❑ les ® ,o Use this form to summarize all disclosure re ortin forms and to total monetary information. 1. Committee Full Name and Fund if a livable 2. T of Re ort 3. ID Number Committee To Elect Dennis Gag Year End OJMOJI Start of Election Cycle: January 1, 2021 Total this Period Total thisReporting Election Cycle 4) 5) 6) 7) 8) 9) 10) 11) Cash on Hand at Start Aggregated Contributions from Individuals Contributions from Individuals Contributions from Political Party Committees Contributions from Other Political Committees Loan Proceeds Refunds/Reimbursements To the Committee Other Receipt Sources Ila) Interest on Bank Accounts l lb) Contributions from Not -for -Profit Organizations 1 le) Outside Sources of Income I ld) Legal Expense Fund — Other Sources 11 e) Exempt Purchase Price Sales (CRO -1105) (CRO -1210) (CRO -1220) (CRO -1230) (CRO -1410) (CRO -1240) (CRO -1250) (CRO -1150) (CRO -1250) (CRO -1270) (CRO -1265) $ 1210.00 $ 0.00 $ 18.13 $ 78.13 $ 1018.95 $ 3876.09 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12) 13) 14) 15) 16) 17) TOTAL RECEIPTS btdd fines 5.6. 7.8.9, 10, Ila, lib, l/c. !!d and lie) URES Disbursements 13a) Operating Expenditures (CRO -1310) 13b) Contributions to Candidates/Political Committees (CRO -1310) 13c) Coordinated Party Expenditures (CRO -1310) Aggregated Non -Media Expenditures (CRO -1315) Loan Repayments (CRO -1420) Refunds/Reimbursements From the Committee (CRO -1320) In -Kind Contributions (CRO -1510) $ 1037.08 $ 3954.22 $ 118.13 $ 118.13 $ $ $ $ $ $ $ $ $ 1110.00 $ 1110.00 $ 1018.95 $ 2726.09 18) TOTAL EXPENDITURES (Add fines iia, 13b, 13c. 14. 15. 16 and 17) $ 2247.08 $ 3954.22 19) 20) 21) 22) 23) 24) 25) 26) 27) 28) Cash on Hand at End (ldd mu,aamd 12 together. thenmbtract line 18) AL INFQ Non -Monetary Gifts Given to Other Committees (CRO -1330) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) Debts and Obligations owed By the Committee (CRO -1610) Debts and Obligations owed To the Committee (CRO -1610) p� Account Transfers Within the C9'Pltf+`�r,U�'1 Y (CRO -1720) N FINANCE Administrative Support OEC 16 2021 (CRO -1710) Forgiven Loans (CRO -1010) 48 -Hour Notice Reports Sum RECEIVED (CRO -2220) Contributions to be Refunded (CRO -1215) $ $ 0.00 $ 0,00 - $ i $' $ $ _:--------- — $ $ $ $ $ $ 1000.00 $ $ CRO -1100 NC State Board of Elections August 2008 Amendment Aggregated Contributions from Individuals Page I of I❑ les ❑ No Optional form used to report NC Contributions From Individuals of $50 or less 1. Committee Full Name and Fund if applicable) 2. ID Number OJMOJ 1 _ _ Committee To Elect Dennis Gav 3. Contributor Information a. Amend b. Account Code C. Form of Payment d. InA%ind Description e. Date mm/dd/ 12/01/2021 f. Amount ❑ Add 01 Cash ❑ Remove ❑ Add $ Remove ❑ Add $ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove Add $ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove Add $ Remove Add $ Remove Add UNION GOONTYE $ Remove ❑ Add U$ CAR4 $ ❑ Remove ❑ ❑Add Remove ❑ Add $ ❑ Remove ❑ Add $ Remove Add $ ❑ Remove 4. Total only this Page $ 18.13 5. Total of ALL CRO -1205 Pages (This line must be on fine 5 of Derailed Summary Page CRO4100) $ 18.13 CRO -1205 NC State Bomd of Elections April 2007 Amendment Contributions from Individuals Pg I of I ❑ Ies ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Fall Name and Fund ifapplicable) 2. ID Number Committee to Elect Dennis Gay OJMOJ 1 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & rip) b. Job Title/Profession d. Comments Salesman William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 28079 (704) 345-8618 c. Employer's Name/Specific Field Steel e. Election Sum to Date $ 2726.09 L Prior g. Account Code Is. Form of Payment L la-fUnd Description j. tate (mm/dd/yyyy) h. Amount ❑ 01 In -Kind Flyers 10/20/2021 $ 95.00 ❑ of In -Kind Flyers 10/26/2021 $ 202.83 ❑ of In -Kind Flyers 11/1/2021 S 152.12 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession it. Comments Salesman William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 28079 (704) 345-8616 c. Employer's Name/Specific Field Steel e. Election Sum to Date $ 2726.09 L Prior g. Account Code It. Form of Payment I. In -Kind Description J. Date (mm/dd4M) L Amount ❑ 01 In -Kind Newspaper Ad 11/27/2021 $ 569.00 ❑ $ ❑ $ 3, Contributor Information ❑ Add ❑ Remove a. Full Name, Rfailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments UNION �`F1N�NCE ,t gpp1GN ilEf, 1 b 2021 c. Employer's Name/Specific Field e. Election Sum to Date $ f. Prior g. Accounta-rRikAkment L to-Kiad Description j. Date (mm/cid/yyyy) 4. Amount ❑ $ ❑ $ 4. Total only this Page $ 1018.95 5. Total of ALL CRO -1210 Pages $ 1018.95 (This line must be on line 6 of DeraRed Sumumry Page CRO -1 100) (RO-1271/ NC State Board of Glectioos April 2007 Amendment Disbursements Pg , or i ❑ yes ® Na Use this form to report expenditures from the committee for; operating expenses, contributions to candidate'political committees and coordinated party expenditures. 1. Committee Full Name and Fund if applicable) 2. ID Number Committee lb Elect Dennis Gav OJM011 3. Type of Disbursement ease use se art CRO-1310 formy for each type of Disburs e ® Operating I xpense, ❑ (ontribulionS lu C;mdidates,'Political C'ummitiees ❑ Coordinated Part) I xpenditurc� 4. Payee Information Add Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments Issac Pittman 1500 Emerald Lake Drive Matthews, NC 28104 (910) 368-0964 e. level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 100.00 E Account Code a. Form of Payment h. Purpose Code L Date (mm/dd/yyyy) J. Amount L Required Remarks 01 Check O 11/22/2021 $100.00 GOTV- Poll Workers $ 4. Payee Information El Add El Remove a. Full Name, Mailing Address & Phone include city, sate & a b. Coordinated Committee Name d. Comments American Bank 312 N Charlotte Avenue Monroe, NC 28112 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 18.13 L Account Code g. Form of Payment It. Purpose Code t. Date (mm/dd/yyyy) j. Amount L Required Remarks 01 Cash O 12/1/2021 $18.13 Bank Fee S 4. Payee information Add Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ E Account Code g, Form o .Purpose Code i. Dale (mmfdd/yyyy) J. Amount k. Required Remarks $ S. Total only this Pae $ 118.13 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Derailed Summurr.V Page CRO -1100 if Operating Expenses) (This lingoes in line 13h of Delailed Sum arg Page CRO -1100 if Co neih to Candidares/Pa/itical Conan) $ 118.13 (This line goes in line 13r of Detailed Summon- Page CFO -1100 if Coordinated Part- EVendilures) 7. Pu Codes List detailed expenditure code in h. above A* - Media B* - Printing C* - Fundraising D -'Ib Another Candidate E - Salaries F* - Equipment G - Political Pane 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 Slate Hoard of Elections December 2009 Amendment Refunds/Reimbursements From the Committee Pg t of t ❑ ves ® No Use this form to report refunds/reimbursements, including contributions returned to the contributor. 1. Committee Full Name andFund if applicable) 2. iD Nmnber C-onunihee I o flegit Deni, Gay t11A11 )1l 3. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state. & zip) d. Type of Committee h. Original Receipt Dale ® Candidate ❑ PAC F1 Referendum Party William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 28079 17041345-8616 e. Level Registered (Specify) i. Original Receipt Amount ❑ Federal ❑ County: State ❑ ® Municipality: $ L Purpose Code J. Election Sum to Date P $ 2726.09 6..106 I ide/Profession c. Employer's Name/Specific Field g. Comments k. Account Code Salesman Steel 01 1. form of Payment on. Required Remarks n. Date (mm/ddlyyyy) o. Amount Chuck Reimbursement of Campaign Expenses 11/29/2021 S 1110.00 3. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) d. Type of Committee h. Original Receipt Date ❑ Candidate ❑ PAC Referendum Party e. Level Registered (Specify) 1. Original Receipt Amount ❑ Federal ❑ County: ❑ State ❑ Municipality: $ L Purpose Code J. Election Sum to Date b. Job Title/Profession c. Employer's Name/Specific Field g. Comments It. Account Code I. form of Payment m. Required Remarks n. Date (mm/d d/yyyy) o. Amount $ 3. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) d. Type of Committee It. Original Receipt Date ❑ Candidate ❑ PAC Referendum Parry GA PA1GN FIN\ qEC } 6 202} e. Level Registered (Specify) L Original Receipt Amount ❑ Federal ❑ County: State ❑ Municipality: $ E Purpose Code j. Election Sum to Date $ b. Job Title/Profession c. Fmplo} er's Name/Specific Field g. Comments It. Account Code I. Form of Payment m. Required Reniarksn. Date (mm/dd/yyyy) o. Amount $ 4. Total only this Page $ 1110.00 5. Total of ALL CRO -1320 Pages (This fine mum be on fine 16 of Detoiled.Sumnwry Page CRO -1100) $ 1110.00 L - Returned to Contributor M - Oh crpay ment for Sero ice N - Exceeded Contribution Limit P' - Reimbursement of In -Kind O` Other ` Codes require detailed explanation in required remarks field m CRO -1320 NC State Board of IlecGons December 2007 Amendment In -Kind Contributions Pg , of , ❑ Yes ® No Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund. use k- Ku -is i:) It to -Nina Lontnnunons were or wni De retunaea wiinin i days. 1. Committee Full Name (and Fund if applicable) _7_21D Number Committee To Elect Dennis Gav j a. Full Name, Mailing Address & Phone (include city, state, & zip) William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 2870 (704)345-8616 e. sseser Flyers Flyers Flyers a. Full .Name. Mailing Address & Phone (include city, state, & zip) William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 28079 (704)345-8616 C uesenption Newspaper Ad 3. Contributor Information a. Full Name, Mailing Address & Phone (include city, state, & zip) 0A\0A�A 'P WEC 16 201\9 b. Type of Contributor ❑ Individual ® Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source E Date (mm/dd/yyy 10/20/2021 10/26/2021 11 12021 b. Type of Contributor ❑ Individual ® Candidate ❑ Parry ❑ PAC ❑ Referendum ❑ Other Receipt Source E Date (mm/dd/yy} 11/27/2021 b. Ty pe of Contributor ❑ Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source E Date (mm/di O1MOJ I e. Comments d. Election Sum to Date $ 2726.09 1) g. Fair Market Amount $ 95.00 $ 202.83 $ 112.12 c. Comments d. Election Sum to Date $ 2726.09 g. Fair Market Amount $ 569.00 $ c. Comments d. Election Sum to Dale $ Market Amount 4. Total onlythis Pae S 1018.95 5. Total of ALL CRO -1510 Pages (This fine must be on fine 17 o Detailed Sum nwYy Page CR&1100) $ 1018.95 'Kfh1510 NC State Board of Elections December 2007