Klaus,Heather_2023-Pre-electionAmendment_ -
Disclosure Report Cover ❑ Yes o No
tJse this form for general report and committee information, most he signed and submitted along with other detailed forms.
DO 1114 u.e I1111 form to undatc inGmnution.
1. Committee Information
i. Full Name
c. ID Number
Ntafiw 0aw
AJAYqD
b. Mailing Address (Include City, State and Zip Code)
d. Date Filed
I ►rL�.11ld I c
e. Phone Number
v1 a 1 , • ' o(W r 1
2. Report Year
3. Period Start Date (mm/dd/yy) 4. Period End Date (mm/dd/ )
5. Treasurer Full Name
X0;3
�� �3 IDS A3
ccf/��v K Ce�cf
6.T y a of Committee Check One)
9. Type of Report (check
only one type of report
fiotn one category)
(Lndwal, Cunpai_n ❑ Pam
Municipal
State/County
Referendum
❑ PAC ❑ Reterendum
❑ Orpanizaoional
❑ Organizational
❑ Oreanizmionul
❑ Independent Expenditure ❑ Joint Fundraiser
❑ Thirty-five day
Quarterly
❑ Pre -referendum
❑ l ecnl Expense Fund
❑ Pre-primary
❑ First
❑ Final
Q'Pre-election
❑ Pre -runoff
❑ Second
❑ Third
❑ Supplemental Final
❑ Annual
. Type of Fund (if applicable, check one)
❑ Rn nWr Fund
Semi-annual
❑ Fourth
❑ Special
❑ Iieddmg Rind
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
10. Special Report Name
❑ Oihee
❑ Final
❑ Special
❑ YearEnd
❑Final
8. Number of Fundraisers this Report
❑ Special
11. Account information
11. Account Information
Financial Institution Full Nome
a Financial Institution Full Name
18anL
. Purpose
c. Amount Code
00,7
. Pu AiG
OCT 3 0 2023
a Account Code
Period Begin Balance
d. Period Begin Balance
$ 39-0.43
$
aC r
CERTIFICATION
1 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 NC State Board of Elections.
Printed Name of Signer Si atu a of Appointed Treasurer Date
OR OFFICE USE ONLY
Delivery Method
Date Received: Q Employee:
❑ Normal Mail
Date Postmarked: Employee: Registered Mail
Hand Delivered
Date Scanned: Employee: Electronically Filed
IE
❑ Signer has not received
Date Data Entered: Employee: ma datory 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 p Yes p No
Use this form ro summarize all dlldosure reporting forms and to total monetary information
1. Committee Full Name (and Fund if appl%able)Type
�G ectai�er CLed
of Report _
$ -
. IDNumber
Ack1 V a,D
Start of Election Cycle: January 1, x019
Total this
Reporting Period
Total this
Election Cycle
4) Cash on Hand at Start I
$ 370. y3
$
RECEIPTS
5) Aggregated Contributions from Individuals (CRO -1205)
6) Contributions from Individuals (CRO -1210)
7) Contributions from Political Party Committees (CRO -1220)
8) Contributions from Other Political Committees (CRO -1230)
9) Loan Proceeds (CRO -1410)
0) Refunds/Reimbursements to the Committee (CRO -1240)
1) Other Receipt Sources
118) Interest on Bank Accounts (CRO -1250)
11b) Contributions from Not -For -Profit Organizations (CRO -1250)
11c) Outside Sources of Income (CRO -1250)
ltd) Legal Expense Fund - Other Sources (CRO -1270)
Ile) Exempt Purchase Price Sales (CR04265)
S
$
$
S
$
S
$
$
$
$
$$
$
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9,10,1la, l lb.I lc, l Id and I le)
$
$
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO -1310)
13b) Contributions to Candidates/Political Committees (CRO -1310)
13c) Coordinated Party Expenditures (CRO -1310)
4) Aggregated Nan -Media Expenditures (CRO -1315)
5) Loan Repayments (CRO -1420)
6) Refunds/Reimbursements from the Committee (CRO -1320)
7) In -Kind Contributions (CRO -1510)
$ a30,129 S
$
$
$
$
ti
$
ti
$
18) TOTAL EXPENDrMRES (Add lines 13a, 13b, 13c, 14, l5, 16 and 17)
$ 4z
>
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$ YO.
S
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 Committ (CRO -1610)
—UNIOt4 '0
3) Debts and Obligations owed to the FINANQ&o-162o)
) Account Transfers Within the Committstt � (CRO-vzo)
5) Administrative Support l�6 F (CRO -1710)
$
$
$
$
$
$ $
6) Forgiven Loans RECE I r� } V O-1440)
7) 48 -Hour Notice Reports Sum (CRO -2220)
$
$
$
$
8) Contributions to be Refunded (CRO -1215)
$
$
CRO -1100 NC State Board of Elections August 2Wa
Amendment
Disbursements Pg — or — 0 Yes 11 No
Use this form to report expenditures from the commitice lor operating expenses. contributions to candidate/political
rronnmitteec and ronrdinqied wriv extiendinir"
� at
-Conumittee Full Nojrwu� (and Fund if applicable)
unt a
t
ID Number
12.
an 11
,pe of Disburseinen(&_- ease use sepahzie CRO -1310 forms for -each tvpe of Disburgi Went.)
06ratini Exunses U L] Coorclin�itcdPinvExl)ciidittire.
13 Add , [3,Remove
I I
Full Name, Mailing Address
a Full in , M iling Address & Phone
(include city, state, & zip)_.. —
b. Coordinated Committee Name
d. Comments
cov",
dntWtP
c. Lcrrll Registered (SpeclFY)__
[:] federal 0-Counly:
[3 state U Municipality:
e. ElectionSmatto Date
$ ?At) aq
r.Account Code
g.Form ofPayment
vl", Com, C7
h. Purpose Code
6
i. Date (mm/dd/yyyy)
qX7X2
J. Amount k Required Remarks
$ ?36,
$
epilyee Informati 67� _rT Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Coordinated Committee No= d. Comments
c. Level Registered (Specify)
[I Federal [] County:
EI state 13 Municipality: e. Election Sum to Date
f. Account Code
g. Furan or Payment
It. Purpow Code
i. Date (mm Idd/yyyy)
Amount
k. Required Remarks
I,$
'JTlyee lifforniation E] Add [I Remove
9. Full Name, Mailing %dd.v,,& Pit...
tricukelty, state, & zip) -lo w '
low"
FINANCE
CAMP
O 't023
OCT 3
b. Coordinated Committee
d. 0).onwnts
c. Level Registered (Specify)
13 Federal _0_C_emrwy__
[I state ❑ Municipality:
e.Election Sum to Date
$
If.AccomatCode
Ig.Form otpaythet
1b.Purpose. Code L Date (mrWdd/yyyy) J. Amount IL Required Remarks
(This line goes In Une 13a of Detailed Summary Page CRO -1100 trOperating Expenses)
(This line goes in line 1315 of Detailed Summary Page CRO -1100 ifComrib to Candidates/Political Comm)
(This line goes in line 13c ofDetailed Summary Page CRO. 1100 ifCoordinaled Partv Expenditures)
'730
x
$
7,Purpose Codes '(List detailed expendiwre code in (It.) above)
A* - Media WO - 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
0* Other
*Codes reoulre dAM&I explanation in re aired remarks field k"oW
CRO -1310 NC Si,irc 13,,md rr Elck Ii ... i, December 2009