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Klaus,Heather_2023-35-DayAmendmeot Disclosure Report Cover p Yes El 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 tidate information. 1. Committee Information . Full Name c. m Number MJAI d 4 J) L . K al -s . mw ft Address andude City, State new zip Code) d. Date Fred /o 3 aa -23 3t�o£�i P�,lck l�eac� �(Wc Indido -CYG.i , WC aftoff) e. Phone Number 70 460-203 2. Report Year 3. Period Start Date (mmtaNyy) 4. Period End Date nmv 5. Treasurer Name a 3 S/03 / 3 9/13 a3 %i • /e/aZrs Committee (Check Ones 9. T of Report (check on one ry re n from one tate ory) Wof andidate Campaign Party PAC [] Referendum Independent Expenditure 0 Joint Fundmiser Legal Expense Fund Municipal Organiaatimal Thirty-five day Pre-primary re-election Pre -runoff State/County Referendum �Organva[ional Pre -referendum ❑ Final Supplemental Final Annual Organirational Quarterly E;r First s! "' qty E3 Second Thud 7. Type of Fund (If applicable. check one) Booster Fund Semi-annual $ Fourth 0 Special Building Fund Mid Year Semi-annual /I�- Other: l t/<< Year End Final O Special Mid Year [3 Year End ❑ Final ❑ Special 10. Special Report Pante 3SdQ y DYI Report 8. Number of Fund 24,P471 _tbis — _ 11. Account Information 11. Account Information . Financial Institution Fall Name a. Financial Institution Full Name FPm 71? i -d ink - -- - - . Purpose e. Account Code Is. Purpote, _ c. Account Code _ -_ CAM'041N Aeptdil.ParlodBeglabalance fi 3$1031°=6pilliq Sloy1a3— 9/(3'a3� E OCT 0 3 2023 9 d. Pertat Begin Radium $ CERTIFICATION N c Ions 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 NSC State Board of Elections. i4ai� i , "i Y1,[,Ia a— /v^L-5�3 Printed Name of Signer Signature of Appointed Treasurer D£te FOR OFFICE USE ONLY Date Received: �� Employee: Delivery Method L.L.I� 13 Normal Mail Date Postmarked: Employee: Employee: Date Scanned: /22 Employee: Registered Mail Hand Delivered Electronically Filed Date Data Entered: Employee: Signer has not received 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-210OA-E) to make committee changes. CRO -1000 NC State Board of Elections August 2008 Detailed Summary ❑ Yat ❑ No Use this form to summarize all disclosure renortino fnrms and to total mnnetnm infnrmatinn 1. Committee Full Nsme_ an app ca le o eport Number. le -c -f 1-k Yhty k l C&n n 3S"0(2w _D M3 -)q Start of Election Cycle: January 1, Total his Period Total thisReporting Election Cycle 4) Cash on Hand at Start $ /0-3/.-92 $ RECEIPTS 5) Aggregated Contributions from Individuals (CRO -1105) 6) Contributions from Individuals (CBO -1110) 7) Contributions from Political Party Committees (CRO -1120) 8) Contributions from Other Political Committees (CRO -1230) 9) Loan Proceeds (CRO -1410) 10) Refunds/Reimbursements to the Committee (CRO -1240) 11) Other Receipt Sources Ila) Interest on Bank Accounts (CRO -1230) 1lb) Contributions from Not -For -Profit Organizations (CRO -1250) Ile) Outside Sources of Income (CRO -1250) l ld) Legal Expense Fund - Other Sources (CRO -1270) Ile) Exempt Purchase Price Sales (CRO -1265) +31. m $ $ $ 1000. °D $ $ $ $ 198 S $ $ $ $ $ $ $ $ $ $ Union P. Board of Elections 12) TOTAL RECEIPTS (Add lines 5,6,7,8,9,10,1 lal lb,l lc,l ld and Ile) $0.00 $ EXPENDITURES -i 13) Disbursements 13a) Operating Expenditures (CR0.1310) 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) $ S/ f $ $ $ $ $ $ $ $ $ $ $ $ $ 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 13. 15, 16 and 17) $0.00q $ 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line IS $0.00 $ ADDITIONAL INFORMATION 0) Non -Monetary Gifts Given to Other Committees (CRO -1330) 1) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) 2) Debts and Obligations owed by the Committee (CR0.1610) 3) Debts and Obligations owed to the Committee (CRO -1620) 4) Account Transfers Within the Committee (CRO -1720) 5) Administrative Support (CRO -1710) 6) Forgiven Loans (CRO -1440) 7) 48 -Hour Notice Reports Sum (CRO -2210) 8) Contributions to be Rdanded (CRO -1215) $ $ $ $ $ $ $ $ $ $ $ $ $ CRO -1100 NC State Board of Elections August '(01 Reset Forr1l Contributions from Other Political Committees Pg or amendment El Yes ❑ No I I'w till, toren to report contributions from other candidate, referendum or PAC commie: r. L Committee Full Naule jand Fund if applicable) 2. 11) Nuniber 3. Contributor Information ❑ Add ❑ Rcutove :L. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Committee ❑ Candidate PAC ❑ Referendum d. Co encs LQelry,,%j-� I C> /yyii �I (i (' l lt^'r , yl u U c. Level Registered (Specify) ❑ Federal � County: ❑ State ❑ Municipality: e. Election Sum to Date $190 ", t- (e .y" f. Account Code g. Form of Payment It. In•Klud Description i. Date (mmtddyyyy) j. Amount $ ti 3 -Contributor Information [I Add ❑ Remove a. Full Name, Mailing Add res. & Thune (include city, state & zip) j� (< OCT 0 3 2023 Union Co. Board of Eie-±;Crl b. "lope of Conunittee ❑ Candidate ❑ PAC ❑ Referendum d. Continents c. Level Registered (Specify) Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ E. -Account Code g. Form of Payment h. In -Kind Description i. Dale (mmtdd/yyyy) -. Amount $ $ $ 3 Contributor Information ❑ Add ❑.. Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) _ _ b. Type of Committee Candidate OPAC ❑ Referendum it. Continents c. Level Registered (Specify) 0—Fede­,.10 County: ❑ State ❑ Municipahty: e. Election Sum to Date . Account Code g. Form of Payment It. In -Kind Description i. Date (mmtddtyyyy) J. Amount elm 0-ec k q het ILuna U kQ o"U"�° (Q ae, $ go. uo Gredl + I a'S $ $ -!.;Total only this Page j y. 8r� S.'I'otal of ALL CRO -12311 Pages I 8 ti (This"tine marl be an liue B a(Detailerl Smmn+ary Page CRO-L]GO( / / � CRO -1230 N($t®, !i i,.i:d of [!caul" April 2007 Amendment Disbursements Pg _ of _ ❑ Yea ❑ No Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political committees and coordinated part ex nditures • frou Name (and Formadriff appca le In Number _Committee — - — ------_12- NC 11e�-tl� N a.(., s _ �1Im 0 b • of Disbursement (Please use seaamte CRO -1310 forms for each tvne of Disbursement.) Operating Expenses U Contributions to CandidatesfPolitical Committees U Coordinated Party Expenditures , Payee Information E3 Add Remove a. Full Name, Mailing Address & Phone include city, state, & zip) Is. Coordinated Committee Nems d. Comments Q Oaw -- 11 II' ,.( 2D Y -N C av'V- tel � ""'— �i K i/ t om, rr^�� n�7 IAn Oral 1' c. Level Registered (Specify) Federal County: ❑ State I-91flunicipatity: ----- -- - - e. Election SSumlt�o Date $ 1 aq.40 - - . Account Code g. Form of Payment ILPurpweCode IL Date (mm/ddtyyyy) . Amount IL Required Remarks $ $ 4. Payee Information ❑ Add RemoNe . Full Name, Mailing Address & Phone (Include city, state, & zip) It. Coordinated Committee Name d. Comments pY t h -r: 1 tx['1 y, ` L 1261 1 OYv CA r -A % I 1 c. Level Registered (Specify) Federal County: ❑ State [l -Municipality: e. Election Sum to Date $ . Account Code g. Form of Payment JILParposeCode 11. Date (urmlddlyyyy) . Amount $ k Required Remarks "AdRemove $ 4. Payee Information . Full Name, Mailing Address & Phone (Include city, state, & zip) b. Coordinated Committee Name d. Comtnents OCT 0 3 2023 Union Co. Board of Elections S CI In[JIFedera, c. Level Registered (Specify) county: ❑ State �Mutdcipahty: e. Election Som to Date $ 4PS 0I . Account Code g. Form of Payment 6. Purpose Code 1. Date (umslddlyyyy) . Amount IL Required Remarb Is I 5. Total only this Page $ Qr0'1+ 6. Total of ALL CRO -1310 Pages (This line goes in line l3a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 '[Coordinated Party Expenditures) t(J 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 He - Holding Public Office Expenses I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* Other * Codes re vire detailed exulanation in re uired remarks field k CRO -1310 NC State Board of Elections Dmember 2009 Disbursements R E C E I V E DAmendment Use this form to report expenditures from the committee forpp1rg1p eWoes, contributions to candid te/politicYes ❑al No committees and cnnrr inarnA ,.a,r., o....es:...-,... III- I 11 7 711"1"{ ,uuw cd vv, v J LVL. 1. ommittee Fu6 Name and Fund if applicable) Z. amber E��G+ �� klQtls Union o. oar o e i �q IM 'AD . Type of fN bursement (Please use separate CRO 2320 forms for each type ofDisbursemeat ) O mun Ex nus Contributions to CandidateslPoliticel Committees Coordinated PanExpenditures 4. Payee Information Add Remove a. Full Name, Mailing Address &Phone b. Coordinated Committee Name d. Comments Include cliy, state & zip) C. Level Registered (SPretty) a l Jn Federal County: ❑ State lu it munieipauty: e. Election Sum to Date (..account Code g. Form of Payment h. Purpose Code G date (mm/ddlyyyy) . Amount k Requhed Remarks $ 4. Payee Information Add Remove . Full Name, Mailing Address & Phone b. Coordinated Committee Name d. Comments (include city, state, & zip) - - - c. Level Registered (spedfy)�=' Lj Federal U County: po-tl.. wD NC 13 State 13 Municipality: W� e. Election Sum to Date $ f. Account Code g. Form oP Payment b. Purpose Code 1. Date (mMdd/yyyy) J. Amount Ill. Required Remarks $ $ 4. Payee Information 0 Add Remove . Full Name, Mailing Address & Phone b. Coordinated Comrnlnee Name d. Comments (Include city, state, & zip) -- Level Registered (Specify) U I - -' / Federel County: Yd I Q n —1 'a I NC, ❑ state ❑ Municipality: e. Election Sum to Date f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/ddlyyyy) ,Amount k Required Remarks E 5. Total only this Page $ 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to CandidateslPolitical Comm) $ � 13V. 1D Dq (Thu line goes in line 13c of Detailed Summary Pae CRO -1100 if Coordinated Party Expenditures) 7. Purpose Codes (List detailed expenditure code in (h.) above) A* -Media Be - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses I* Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O Other * Codes require detailed explanation in required remarks field W CRO -1310 _ _ ..- Wale nvnm 01 Erections December 1009 Disbursements Amendment R E C E I V E*�- �- ❑ Yes ❑ No Use this form to report expenditures from the committee for operating exppeenses, contributions to candidate/political committees and nnnsdinatnA .. e..d:...___ "m nni,n ttee1 Neme (and Fund If 8PPI 12. ED Number 0-ec} 4ecltke(' Klow s Union Co. Board of Elections b 3. Type of Disbursement (Please use separate CRO 1310 forms for Goch tune of Disbursement ) O eratin Ex ses Contributions to Candidates/Polincal CommitteesExpenditures- --_--- --- Coordinated Part 4. Payee Information U Add Remove a. Full Name, Mailing Address & Phone It. Coordinated Committee Name d. Comments Include cl ,state, & zip) � 1 roes f KO V t/ 1 �� pan ' a LCC c. Level Registered (Specify) 11 l.. l..l.. A� te-e U4n Federal U County: ❑ State ❑ Municipality: e. FAedion Sum to Date $ f. Account Code g• Form of Paywent h Pu Purpose Code L Date (mm/ddlyyyy) . Amount L Required Remarks 4. Payee Information E3Add G Remove . Full Name, Mailing Address & Phnne (include city,, state, & zip) boarU 6f �(�.( 75}90 _ -- -- b. Coordinated Committee Name d. Comments c. Level Registered (Specify) Federal 0 County: ❑ State Q' r�tunictpality: `C e. Election Sum to Date $ S-00 f. Account Code g. Form of Payment It, Purpose Code L Date (mm/ddlyyyy) . Amount IL Required Remarks 4. Payee Information L3 Add Remove . Full Name, Malting Address & Phone (Include city, slate, & zip)----- b. Coordinated Committee Name d. Comments -- - r`rJ'I 1 �� c. Level Regiffhoed (RI V all s I _ NC Federal County: ❑ state "Municipality: e. Election Sum to Date $ I TU f_Account Code g. For2wirlayme nt h. Purpose Code I. Date (rnndddlyyyy) J, Amount k Regmdred Remarks $ . Total only this Page 6. Total of ALL CRO -1310 Pages $ O (This line goes in line 13a of Detailed Summary Page CRO.1100 if Operating Expenses) (This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm) (Thu line roes in line 13c of Detailed Summary Pa a CRO -1100 if Coordinated Party Expenditures) //-- L' $ ((J%. 70 7. PUI•pose Codes (List detailed expenditure code in (h.) above) A* - Media B* - Printing C* - Fundraising D - To Another=Ofrice Salaries F* - Equipment G - Political Party H* - Holding PsesPostage J - Penalties K* - Ofice Expenses Q* - Donation und O Other * Codes r uire detailed Ianation is r tared remarks field k CR -1 l0 vC State Board of Elections December 2009