Palacios,Maria_2022-3rd-report-coverAmendment
Disclosure Report Cover ❑ Yes IM No
Use this form for general report and committee information, must be signed and submitted along with other detailed fours.
Do not use this form to update infonnation.
1. Committee Information
a. Full Name
c. ID Number
COMMITTEE TO ELECT MARIA PALACIOS
XXX-OJMK89-X-XX
b. Mailing Address (include City, State and Zip Code)
d. Date Filed
3903 GARRISON CT
10/31/2022
MONROE, NC 28110
e. Phone Number
(704)207-5519
2. Report Year
13. Period Start Date (mm/dd/yy)
4. Period End Date (mm/dd/yy)
15. Treasurer Full Name
2022
07/01/2022
10/22/2022
CRISTAL ROBINSON
6. of Committee Check One)
9. TvIvive
of Re rt check only one type o re ort from one category)
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ Joint Fundraiser ❑ PAC
❑
Organizational
❑ Organizational
❑ Organizational
❑ Referendum ❑ Legal Expense Fund
❑
❑
❑
Thirty-five day
Pre-primary
Pre-election
Quarterly
❑ First
❑ Second
❑ Pre-referendtmt
❑ Final
❑ Supplemental Final
7. Type of Fund (if applicable. check one)
❑ 'Booster Fund'
❑ Building Fwd
❑
Pre -runoff
❑ Third
❑ Annual
❑ Presidential Election Year Candidates Fund
Semi-annual
❑ Fourth
❑ Special
❑ NC Public Campaign Financing Fund
❑
Mid Year
Semi-annual
❑
Year End
❑ Mid Year
10. Special Report Name
❑ Other
❑
❑
Final
Special
❑ Year End
❑ Final
❑ Special
8. Number of Fundraisers this Report
I
3. Account Information
3. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
FIRST CITIZENS BANK
1). Purpose
c. Account Code
b. Purpose
c. Account Code
COMMITTEE
BO 1
d. Period Begin Balance
d. Period Begin Balance
S
S
CERTIFICATION
1 certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 22D -22M of
Chapter 163 ofthe NC General Statutes and that no funds are commingled with prohibited or other non -disclosed
funds. 1 further certify that this report is complete,
true and correitnd thI-tiave been trained by the NC Stale Board
10/31/2022
PrintedN eof Signer
Sdgnat ireAppoint ed Treasurer Date
FOR OFFICE USE ONLY
Date Received:
Employee: Delivery Method
❑ Normal Mail
Date Postmarked:
Employee: Registered Mail
Hand Delivered
❑ Electronically Filed
Date Scanned:
Employee:
❑ Signer has not received
Date Data Entered:
Employee:
mandatory training
Please Note: This fomncannot 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 ofOr anization(CRO.2100A-E to make committee changes.
CRo-7000 NC State Board of Elections December 2007
Detailed Summa Amendment
�' 0es ®No
Use this form to summarize all disclosure reporting fours and to total ntonetary information
1. Committee Full Name and Fund if applicable)
2. Tyx of Report
13. m Number
COMMITTEE TO ELECT MARIA PALACIOS
2022 Third Quarter
XXX-OJMK89-X-XX
Start of Election Cycle: January 1, 2021
Re
Total this
rtin Period
Total this
Election Cycle
4) Cash on Hand at Start
$
346.46
$
0.00
RECEIPTS
5) Aggregated Contributions from Individuals
6) Contributions from Individuals
7) Contributions from Political Party Committees
8) Contributions from Other Political Committees
9) Loan Proceeds
0) Refunds/Reimbursements to the Committee
I) Other Receipt Sources
I I a) Interest on Bank Accounts
IIb) Contributions from Not -For -Profit Organizations
I lc) Outside Sources of Income
IId)L.egalExpenseFund - Other Sources
Ile) Exempt Purchase Price Sales
(CRO -1105)
(CRO -1210)
(CRO -1210)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
(CRO -1150)
(CRO -1150)
(CRO -1270)
(CRO -1265)
$ 170.08
$
552.37
$ 1,467.18
$
2,647.82
$ 50.00
$
100.00
$ 0.00
$
0.00
$ 771.18
$
1,257.18
$ 0.00
$ 0.00
$
$
0.00
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
2) TOTAL RECEIPTS (Add lines 5, 6,7, 8, 9, 10,11 a. I I b. I I c, I Id and I I e)
$
2,458.44
$
4,557.37
EXPENDITURES
3) Disbursements
13a) Operating Expenditures
13b) Contributions to Candidates/Political Committees
13c) Coordinated Party Expenditures
4) Aggregated Non -Media Expenditures
5) Loan Repayments
6) Refunds/Reimbursements from the Committee
7) In -IQ nd Contri bu tions
(CRO -1310)
(CRO -1310)
(CRO -1310)
(CRO -1315)
(CRO -1410)
(CRO -1320)
(CRO -1510)
$
1,037.13
$
2,050.32
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 323.29
$
710.57
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 1,108.00
$
1,460.00
8) TOTAL EXPENDITURES (Add lines 13a. 13b, 13c, 14, 15,
16 and 17)
$
2,468.42
$
422089
9) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18)
$
336.48
$
336.48
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees
1) Outstanding Loans (incl. ones from other campaigns)
2) Debts and Obligations owed by the Committee
3) Debts and Obligations owed to the Committee
4) Account Transfers Within the Committee
5) Administrative Support
6) Forgiven Loans
7) 48 -Hour Notice Reports Sum
(CRO -1330)
(CRO -1430)
(CRO -1610)
(CRO -/610)
(CRO -1710)
(CRO -1710)
(CRO -1440)
(CRO -2220)
$ 0.00
$ 1,257.18
-
$ 0.00
$ 0.00
$ 0.00
-
$ 0.00
5
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
8) Contributions to be Refunded
(CRO -1215)
$
0.00
C'R(.A-lI00 NC slate Hoardoi Elections August 2008
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9505514860562305826062
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Your item has been delivered and is available at a PO Box at 2:44 pm on November 2, 2022 in MONROE, NC 28110.
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MONROE, NC 28110
November 2, 2022, 2:44 pm
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MONROE, NC 28110
November 2, 2022, 9:51 am
Arrived at Post Office
MONROE, NC 28110
November 2, 2022, 4:12 am
Departed USPS Regional Facility
MID CAROLINA -CHARLOTTE NC DISTRIBUTION CENTER
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Arrived at USPS Regional Facility
MID CAROLINA -CHARLOTTE NC DISTRIBUTION CENTER
November 1, 2022, 7:24 pm
Departed Post Office
CHARLOTTE, NC 28277
November 1, 2022, 5:09 pm
USPS in possession of item
CHARLOTTE, NC 28277
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