Pierce,Rodney_2023-MY-amendDisclosure Report Cover Am Yrament ❑ 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 undate information.
to rstecmons August 2008
7. V_N5,nN.t Lt;51.11111, elk i
a. Poll Name • . ' • . ^ ,, ".
:. .. .. ..
c: IA Number
Efe
b: Mailing Address (include City,- to and Zip Code,
Dale Filed +, -. .,, •>
3 five
oiA Rid.
be
11C N�
e: Phnna • .. f
rD�
r •O l ,
" Iqts vr
'�'l0
Ite'ort�Yea'r
3 pe "`6 Start afe' ii frit ld7
4 P -.err id End D"te. aar"')
5: Tfea§firer FullxNatne; °i. t
P[�:]161L,
I azQ�
'o
. G E-Q-hoks
Cai!date Campaign ❑ Pit
Municipal . ,
State cimatty '-
Referendum ` +
❑ PAC ❑ Referendum
❑ Organisational
❑ Organizational
❑ Organizational
❑ Independent Expenditure ❑ Joint Fundraiser
❑ Thirty-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑ Pre-primary
13 Fust
❑ Final
❑ Pre-election
❑ Pre -runoff
❑ Second
❑ Third
❑ Supplemental Final
❑ Annual
7'f • lOfFFllll'd'`t? (r uppJleab(im"c�ucE ane}it
❑ Booster Fund
Semi-annual
❑ Fourth
❑ Special
❑ Building Fund
❑ Mid Year
Semi-annual
❑ Year End
Mid Year
❑ Other.
❑ Final
❑ Special
Year End -
Final
$ „either of'Fjii ' aers;this+Repor} ., ix;
❑ Special
IsI� ceount.ihforin3ttiittt5�r "-�` �._ r; a;�^'"`
l Name4.
Purpose
aAccmmtCode,, =`
FPaurpqqie,'1
eaw pCx 5v\
d. Period Beldhaalance:.d.
Period.�Begin Balance �"'J.''
$ D3
$
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 NC State Board of Elections.
-/Ze4e� )'_e a -a- 9 -
printed Name of Signer Signature of Appointed Treasurer Date
FOROFFICE USE ONLY,
�a
�•/ Delivery Method
Date Received: Employee: : a
, ,
Normal Mail
Postmarked ' ' Employee +Q Registered Mail
,Date
! Mand Debvered t' .
- ' Date Scanned: ,_ , Employee.r Electronically Filed a
' f ;•.= , ,
ti f = ��]"Signer has not received - ,
Date Data Entered Employee: ' •
_ , •;mandato .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 committeechanges.
to rstecmons August 2008
Am meat
Detailed Summary
Use this form to summarize all disclosure renorting forme and to total monetary inffinnntinn
u
4,'Cordmftte6.F 11.�Ng#ii!!(a4d�Fiiiid;ffgfOpli
2 2. ;jV 6! V port
:Ablel�
C �e
�Ie�
Start of Election Cycle: January 1.
Total this
Total thisReM2rnt!*aLP2E!2dE.__ Election Cycle
4) Cash on Hand at Start
$ 0?)
$
LCEIPTS,
5) Aggregated Contributions from Individuals (CRO -120S)
ZAq
$
'Z,, ON AIh
$
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)
$
$
10) Refunds/Reimbursements to the Committee
(CRO -1240)
$
$
11) Other Receipt Sources
11a) Interest on Bank Accounts
(CRO -125O)
$
$
11b) Contributions from Not -For -Profit Organizations
(CRO -1250)
$
$
Ile) Outside Sources of Income
(CRO -1250)
$
$
11d) Legal Expense Fund - Other Sources
(CRO -1270)
$
$
Ile) Exempt Purchase Price Sales
(CRO -1265)
$
$
12) TOTAL RECEIPTS (Add lines 5,6,7,8,9,10,1 laj lb,l Ic,l ld and 1 le)
$
$
EXPENDITUREV;-: , -! � - �� e,
-- L2 .. i.p
-1. ,
w
13) Disbursements
MM
13a) Operating Expenditures
(CRO -1310)
$ d
$
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)
$
18) TOTAL EXPENDITURES (Add fines 13a, 13b, 13c, 14,15,16 and 17)
$
$
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18:
$
$
op3-1
g
li"OU
20) Non -Monetary Gifts Given to Other Committees
(CRO -1330)
$
21) Outstanding Loans (incl. ones from other campaigns)
(CRO -1430)
$
22) Debts and Obligations owed by the Committee
(CRO -1610)
$
23) Debts and Obligations owed to the Committee
(CRO -1620)
$
24) Account Transfers Within the Committee
(CRO -1720)
$
25) Administrative Support
(CRO -1710)
$
26) Forgiven Loans
(CRO -1440)
$
$
P7) 48 -Hour Notice Reports Sum
(CRO -2220)
$
$
128) Contributions to be Refunded
(CRO -1215)
$
$
60 Au bune Bossa or elections August 2008
Amendment
Forgiven Loans Pg .1 ofLPI Yes Q No
Use this form to report any loan which has been forgiven by the lender.
A Forviven Innn statement (f`RfL690111 mnst .—h t...,..
i�,. oYpmitfee: ,
-/
0&4'Ewe Clerk- G/j CO rf
_Gt p c
n"der InforDtai) d. fta d.. r h F y:v ._❑ d d �tegt rYe t K : fi t t
.. i.x,�.i:9,.. .t sa
a. FWIVame, Mailing; Address'&Phone
(include city, state, &ilp)
�y-QGJ� NG a�ila
e.,Odal,Loa t Date (mm/dd/yyyy)'
gmh
„ f •Election Sum to,Date.
a l
$
d.OriginolLoa¢.Ani ount,,.:
g.Date(mm/dd/yyyy,):;z,;;,a ==,1
$ LI55
e..Rem_ain(n`gloaa Balance 4A!
h: Fotgive¢Amount„;'} x";
$ 5s
$ 55
Informakl r
3 • oder, C� a _.=r . > �� ❑ Add; a emove
.; :, t 3
a^Full Name, MailingArl ess & Phone .ix
t • (include etty, stale, &yip
b. Comments
xi x
c: Orig(nhl Loan Date (maddd/yyyy)
L Electian'Sum to
$
d. Original LainAmemt +=,�
g. Data(muldd/yyyy),.a?
$
e: ReaiainiugT.oan:Balance „.°`'i,(sh.
Forgiven Amount-�)${..�._�;�;•„
n8z Infoillti>sadd r
a. -Full Name, Mailing Address&Phone r
.;(include city, elate,&ripkrw
40
b^Cami'neats
e^ OrlginatLoatt Date (mm/dd/yyyy)�
f. Election: Stan to Date
d: Oii, sinal=r•oa¢'Amount ; .;,:.
g,' -Dat( (mS¢!dd/yyyy ,",axe `:+STM•
e. Reinatuing:Loan Balance
_^.Forgiven
:am`.
;7 a u x-avw^ xx�i?.
The tender informotionshould contain thesomeinjormatlon as supplied on the gdgrnal Joan proceed stafemenf
nnn vin
.,, z -� ;.°<
NC State Board of Elections December 2007
vo NORTN CARO.LIN.A
.S`TATE'BOAR.D4 01'ELECTIONS
Forgiven Loan Statement
This form is used to report a loan that has been forgiven by the lender. The lender's signature is required
on this form and it must accompany the next filed report.
This Statement Is to be fitith the Elec Board where the committee's reports are filed.
Ce,611ja
I, I< VAIVCP� , do not wish to be reimbursed for the amount
of the loan indicated above* and will consider the amount loaned a contribution to the
committee.
I understand and confirm no other parties are responsible for payment of this loan. I
may not forgive a loan for which there is an outstanding' balance owed to any source.
Signature of Lender
ignature of Committee Treasurer
CRO -6200 - Forgiven Loan Statement
Name of Lender:
at
I Y?e et�2 C�e o Co
Committee receiving loan:
Date of loan: I`7 (�,�
Amount of original loan. IQ5,S
*Amount of loan to be forgiven:
��55