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Gay,Dennis_2021-PreElectionReportAmendment 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 nol use this form to update information 1. Committee Information D a. Fall \acne c. ID Number Committee To Elect Dennis Gay OCT 2 5 2021 OJMOJI b. Mailing Address (include City, State and Zip Code) Union Co. Elections it. Date Filed 4705 Pioneer Lane Indian Trail, NC 28079 10/25/2021 Fe . Phone Number (350 723-1525 2. Report Year 3. Period Start Date (mm/dd/yy) 4. Period End Date mm/dd/ 5. Treasurer Full Name 1021 7: I � 103 I 10/182021 Randall Haron Gay 6. Type of Committee (Check One) 9. Type of Report check only one iyjm n report om one category) ® Candidate Campaien ❑ Party Municipal State/County Referendum ❑ PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational Independent ❑ Joint Fundraiser ❑ Expenditure ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ ® Pre-primary Pre-election ❑ First ❑ Second ❑ Final ❑ Supplemental Final 7. Type of Fund fYjapplicable, check oae/ ❑ "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 li 11. Account Information 11. Account Information a. Financial Institution Full Name a. Financial Institution Full Name American Bank b. Purpose c. Account Code b. Purpose c. Account Code Campaign 01 expenses it. Period Begin Balance it. Period Begin Balance $ 0.00 $ CERTIFICATION 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 NCS to Boar} f Electio Randall Haron Gay Printed Name of Signer Signature of Appointed Treasurer tiate FOR OFFICE USE ONLY Date Received: %� a` Delivery Method Employee: ❑ Normal Mail Date Postmarked: Employee: Registered Mail Hand Delivered Date Scanned: Electronically Filed Employee: ❑ 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 C�CQC�T[ D Amendment Detailed Summary OCT 2 5 2021 ❑ Yes ® No Use this form to summarize all disclosure renortinC forms and to totj monetary information. 1. Committee Full Name and Fund if app licable 2. T 0- eCtion 3. H) Number Committee To Elect Dennis Gay Pre -Election OJMOJ I Start of Election Cycle: January 1, 2021 Total this Reporting Period Total this Election Cycle 4) RE 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 I lb) Contributions from Not -for -Profit Organizations Ile) Outside Sources of Income l ld) Legal Expense Fund —Other Sources 11 e) Exempt Purchase Price Sales (CRO -1205) (CRO -1210) (CRO -1220) (CRO -1230) (CBO -1410) (CRO -1240) (CRO -1250) (CRO -1250) (CRO -1250) (CRO -1270) (CRO -1265) $ $ 0.00 60.00 $ $ 1210.00 60.00 $ 2857.14 $ 2857.14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12) 13) 14) 15) 16) 17) TOTAL RECEIPTS (Addlines5, 6, 7, 8, 9, 10, Ila, llb, Ilc, Ildand Ile) 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) $ 2917.14 $ 2917.14 0 $ $ $ $ $ $ $ $ $ $ $ $ $ 1707.14 $ 1707.14 18) TOTAL EXPENDITURES (Add lines 13a. 13b, 13c, 14, 15, 16 and 17) $ 1707.14 $ 1707.14 19) 20) 21) 22) 23) 24) 25) 26) 27) 28) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18) 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 -1620) Account Transfers Within the Committee (CRO -1710) Administrative Support (CRO -1710) Forgiven Loans (CR04440) 48 -Hour Notice Reports Sum (CRO -2220) Contributions to be Refunded (CRO -1215) $ $ $ $ $ $ $ 1210.00 $ $ 1210.00 $ $ $ 1000.00 $ 1000.00 $ $ CRO -1100 NC State Bound of Elections August 2008 OCT 2 5 2021 Aggregated Contributions from Individua �lni0n Co �[l page - Optional form used to report NC Contributions From Ind si3f`$S0 or less Amendment of I ❑ ves ❑ No 1. Committee Full Name and Fund if applicable) 2. ID Number Committee I o Flect Dennis Gay OJ MOJ I 3. Contributor Information a. Amend b. Account Code C. Form of Payment d. In-kind Description e. Date mm/dd/ f. Amount ❑ Add Ol Check 10/08/2021 $ 50.00 ❑ Remove Add 01 Check 10/08/2021 $ 10.00 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 $ ❑ Remove ❑ Add $ ❑ Remove Add $ Remove Add $ Remove Add $ ❑ Remove 4. Total only this Page $ 60.00 5. Total of ALL CRO -1205 Pages (This line must be online S of Detailed Summary Page CR&I100) $ 60.00 CRO -1105 NC State Board of Elections April 2007 0 Amendment Contributions from Individuals OCT 2 5 2021 g I of 2 [:]Yes ® No Use this form to report individual contributions wpr,$50 or contributions u der $50 if form CRO 1205 is not used mittee Full Name (and Fund if a li 'CtI0t1S 2. fD Number Committee to Elect Dennie Gay �. OJMOj 1 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, sate, & zip) b. Job Title/Profession d. Comments Retired William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 28079 (704) 345-8618 c. Employer's Name/Specific Field C. Election Sum to Date $ 1857.14 f. Prior g. Account Code h. Form of Payment i. In -Kind Description I. Date (mm/dd/yyyy) k. Amount ❑ 01 In -Kind Filing Fee 07/14/2021 $ 5.00 ❑ 01 In -Kind Yard Signs 09/01/2021 $ 597.00 ❑ 01 In -Kind Yard Signs 10/07/2021 $ 119.56 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, sate, & zip) b. Job Title/Profession it. Comments Retired William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 28079 (704) 345-8616 c. Employer's Name/Specific Field e. Election Sum to Date $ 1857.14 f. Prior g. Account Code h. Form of Payment 1. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 01 In -Kind Trunk or Treat 10/07/2021 $ 101.16 ❑ 01 In -Kind Trunk or Treat 10/08/2021 $ 39.25 ❑ 01 In -Kind Postage 10/14/2021 $ 464.00 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, sate, & zip) b. Job Title/Profession d. Comments Retired William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 28079 (704) 345-8616 c. Employer's Name/Specific Field e. Election Sum to Date $ 1857.14 f. Prior g. Account Code h. Form of Payment I. In -Kind Description j. Date (mm/dd/yyyy) It. Amount ❑ of In -Kind Copies 10/07/2021 $ 101.16 ❑ 01 In -Kind Color Copies 10/08/2021 $ 39.25 ❑ 01 In -Kind 1 0 /1 3/2021 $ 140.00 4. Total only this Page $ 1640.47 5. Total of ALL CRO -1210 Pages $ 2857.14 (This Ilne must be online 6 vi Derailed Sunuva" Page CRO -1100) CRO -1210 NC' State Board of Elections April 2007 C3C��C��M�D `i('T 2 5 ?011 kmendment Contributions from lntln (duals' ' Pg 2 of 2 ❑ Yes ® NO Use this form to report individu,d CwMu ihulion> Over S50 Ol C I'll II I NIIIIII I under $50 if form CRO 1205 is not used 1. Committee Full Name (and Fund i a icable) 2. fD Number Committee To F.lect Dennis Gay OJMOJ I 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, sate, & zip) b..lnh 7 Ile/Profession it. Comments Retired William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 28079 (704) 345-8616 c. Employer's Name/Specific Field c. Election Sum to Date $ 1857.14 E Prior g. Account Code h. Form of Payment i. In -Kind Description I. Date (mm/ddlyyyy) L Amount ❑ 01 In -Kind Newspaper Ad 10/13/2021 $ 66.67 ❑ 01 Check Fund Check Acct 07/21/2021 $ 150.00 ❑ $ 3. Contributor Inforaiatlon ` ❑ Add ❑ ' Remove a. Full Name, Mailing Address & Phone (include city, sate, & zip) b. Job Title/Profession It. Comments Self-Employed/Owner James Howard Cherry 319 Medearis Drive Charlotte, NC 28211-6043 (704) 821-6425 c. Employer's Name/Specific Field Carolina Made/Apparel c. Election Sum to Date $ 1000.00 L Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) h. Amount ❑ 01 Check 10/08/2021 $ 1000.00 ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, :Mailing Address & Phone (include city, state. & zip) b. Job Title/Profession it. Comments c. Employer's Name/Specific Field c. Election Sum to Date $ E Prior g. Account Code h. Form of Payment i. In-kind Description J. Date (mm/dd/yyyy) k Amount ❑ $ ❑ $ ❑ $ 4» Total only this P e $ 216.67 5. Total of ALL CIRO-1210 Pages (Twlsdn Inst be on me6OfDaidiedSaannaary PageCRO-1100) $ 2857.14 CRO -12/0 NC State Board of Elections April 2007 F Amendment In -Kind Contributions Pg I or z ❑ Yes ® No Use this form to report non -monetary contr;n%5n2.Q.�ods services provided to the committee or fund. Use CRO -1215 if In -Kind Contributions w be refunded within 7 days - 1. Committee Full Name (and Fund if tip 2. ID Number — -- – – --- Committee To Elect Dennis GaN MUM I 3. Contributor Information . Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & tip) b. Type of Contributor c. Comments ❑ Individual ® Candidate ❑ party ❑ PAC ❑ Referendum ❑ Other Receipt Source William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 2870 (704) 345-8616 d. Election Sum to Date $ 1707.14 e. Descriptioa 4 Date (mm/dd/yyyy) g. Fair Market Amount Filing fee - Cash 07/14/2021 $ 5.00 Yard Signs 09/01/2021 $ 597.50 Yard Signs 10'07/2021 S 119.56 3. Contributor Information' ❑ Add Remove ' a. Full Name, Mailing Address & Phone (include city, sate, & tip) b. Type of Contributor C. Comments ❑ Individual ® Candidate ❑ Parry ❑ PAC ❑ Referendum ❑ Other Receipt Source William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 28079 (704) 345-8616 d. Election Sum to Date $ 1707.14 e. Description E Date (mm/dd/yyyy) g. Fair Market Amount Trunk or Treat (Candy) 10/07/2021 $ 101.16 Trunk or Treat (Candy) 10/08/2021 $ 39.25 Postage 10/14/2021 $ 464.00 3. Contributor Information Add 101Remove a. Full Name, )failing Address & Phone (include city, state,& zip) b. Type of Contributor c. Comments ❑ Individual ® Candidate ❑ Party ❑ PAC ❑ Referendum ❑ (-Aber Receipt Source William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 28709 (704) 345-8616 d. Election Sum to Date $ 1707.14 e. Description E Date (mm/dd/yyyy) g. Fair Market Amount Copies 9/20/2021 $ 60.00 Color Copies 9/30/2021 $ 114.00 Flyers 10/13/2021 $ 140.00 4. Total only this Pae S 1640.47 5. Total of ALL CRO -1510 Pages 1707.14 (This fine must he on Une 17 of Demiled Summa" Page CRO -1100) CRO -1510 NC State Board of Elections December 2007 rct)r..Nw�iill ��..' `-•.'SD Amendment In -Kind Contributions ((�TT Pg 2 of 2 ❑ Yes ® No Use this form to report non -monetary contrUbn9i§n�Vo�ds o services provided to the committee or fund. Use CRO -1315 if In -Kind Contributions tv be refunded %Nritbi t 7 days. 1. Committee Full Name and Fund if a 2. ID Number Committee To Elect Dennis Gay OJMOJ I 3. Contributor Information Cj Add Remove a. Full Name, Mailing Address & Phone (include city, state, &zip) b. Type of Contributor c. Comments ❑ Individual ® Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source William Dennis Gay 4705 Pioneer Lane Indian Trail, NC 2870 (704) 345-8616 d. Election Sum to Date $ 1707.14 e. Description E Date (mm/ddlyyyy) g. Fair Market Amount Newpaper Advertsement (CMG) 10/13/2021 $ 66.67 3. Contributor Information Add - Remove a. Full Name, Mailing Address & Phone (include city, state, &zip) b. Type of Contributor a Comments ❑ Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source d. Election Sum to Date $ e. Description E Dale (mm/dd/yyyy) g. Fair Market Amount $ 3. Contributor Information Add Remove a. Full Name, Mailing Address & Phone (include city, statq&zip) b. Type of Contributor c. Comments ❑ Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source d. Election Sum to Date $ e. Description E Date (mm/dd/yyyy) g. Fair Market Amount $ $ $ 4. Total only this Pae $ 66.67 5. Total of ALL CRO -1510 Pages (TRIS One maul be on line l7 of Derotled Sumnwn• Page CRD -1100) $ 1707.14 CRO -1510 NC State Board of Elections December 2007