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Schallenkamp,Dan_2023-Org-reportAmendmeat Disclosure Report Cover o Yw o 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. 1. Committee Information . Full Name c. ID Number I . Mailing Address (Include City, State and 4 Code) d. Date Filed Y'0 g ivir�`��22�� 19 7v�P-aoa3 �Q��.�5, e. Phone Number 70N-x/54-ay6 2. Report Year 3.. Period Start Date (mmlddlyy) 4. Period End Date (mm/dd/yy) 5. Treasurer Full Name 6Type of Committee (Check One) 9 Type of Report (check only one of report front one category)( Municipal C: ndida:c Campaign ❑ pant' N State/County Referendum PAC ❑ Referendum _ Organizational ❑ Organizational ❑ Organizational ❑ Independent Expenditure ❑ Joint Fundraiser Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ Pre-primary ❑ First ❑ Final ❑ Pre-election ❑ Pre -runoff ❑ Second ❑ Third ❑ Supplemental Final ❑ Annual 7. Type of Fund (if applicable, check one) _!! ❑ Semi-annual ❑ Fourth ❑ Special ❑ 6uldin R:nd ❑ Mid Year Semi-annual ❑ Year End ❑ Mid Year 10. Special Report Name ❑ Oilier ❑ Final ❑ special ❑ Year End [3 Final 8. Number of Fundraisers this Report ❑ Special 11. Account Information 11. Account Information a. Financial Institution Full Name it. Financial Institution Pull Name It. Purpose I C. Account Code b. Purpose � 'q7^ c. Account Code GctvtlpOki h ��lr -4- it. Period Begin Balance d. Period Begin Balance o F r, F 4�! F D $ - $ 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. 1 further certify that Ilii, report is complete, true and correct and that 1 have been trained by the NC State Board of Elections. Printed Name of Signer Upointed Treosurer Date FOR OFFICE USE ONLY Delivery Method Date Received: Employee: ❑ Normal Mail Registered Mail Date Postmarked: Employee: Hand Delivered Date Scanned: Employee: Electronically Filed 9] 7 I Date Data Entered: ' 1 Employee: ❑ Signer has not receivedmandatory 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 Detailed Summary 1 Yz " ❑ No Use this form to summarize all disclosure re orcin z forms and to total monetary information 1. Committee Full Name (and Fund if appl- ble)_ 2. Type of Report 3. ID Number Start of Election Cycle: January , �z oa Total this Period Total thisReporting Election Cycle 4) Cash on Hand at Start $ $ RECEIPTS 5) Aggregated Contributions from Individuals 6) Contributions from Individuals (CRO -1205) (CRO -1210) $ $ ()05, i $ $ .0,0- 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 -1250) $ $ 11b) Contributions from Not -For -Profit Organizations (CRO -1250) $ $ Ile) Outside Sources of Income (CRO -1250) $ $ Ild) Legal Expense Fund - Other Sources (CRO.1270) $ $ Ile) Exempt Purchase Price Sales (CRO -1265) $ $ 12)TOTAL RECEIPTS (Add lines 5,6,7,8,9,lll,lIa,IIb,IIc,IIdand Ile) $ �.00] 1tj 5 EXPENDITURES 13) Disbursements 13a) Operating Expenditures (CRO -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 (CR0-1320) $ 5 17) In -Kind Contributions (CRO -1510) $ 5,0- $ 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ rj,� $ 5,c� 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line IS $ 310 $ odd -Of/ ADDITIONAL INFORMATION 20) Non -Monetary Gifts Given to Other Committees (CRO -1330) $ $ 1) Outstanding Loans (incl. ones from other campaigns) 2) Debts and Obligations owed by the Committee (`( 3) Debts and Obligations owed to the G60ouittee 24) Account Transfers Within the Committee (CRO -1430) CRO -1610) (CRO -1620) (CRO -1720) $ $ $ $ $ 5) Administrative Support 1710) 26) Forgiven Loans —(CRO -1440) $ $ 7) 48 -Hour Notice Reports Sum Contributions to be Refunded (CRO -2220) (CRO -1215) $ $ $ $ CRO -1100 NC State Board of Elections August 2008 Amendment Contributions from Individuals Pg of ❑ res ❑ No ll>e this form to report individual contributions over 450 of contribution, under $50 it form CRU 1-20S is not used 1. Committee Full Name (and Fund iff/ applicable) 2. ID Number 3. Contributor Information ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession c. EmplMTNeeiPe Field Ao+ cy# d. Comments e. Election Sum to Date $ 3, 0OF,, . Prior ❑ g. Account Code 601 It. Form of Payment 1(an5�er I. In -Kind Description J. Date (mm/dd/yyyy) 1�1 �vQ-ci0a'13 k Amount $ 13Cn4diOc e�rrn� rXf �Qe $ ❑ $ 3. Contributor Information. ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) b. ,lob Ti ie/Profession d. Comments c. Employer's Name/Specific Field e. Election Sum to Date $ f. Prior 11 g. Account Code It. Form of Payment 1. In -Kind Description . Date (mm/dd/yyyy) It. Amount S ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (Include cilli, stole, & zip) b. Job Title/Profession d. Comments c. Employer's Name/Specific Field e. Election Sum to Date I. Prior g. Account Code It. For- oftotlihint i. -Kind Description J. Date (mm/ddlyyyy) k Amount ❑ C $ ❑ $ 4. Total only this Page $ 31 ao s9 552- 5. 1Total of ALL CRO -1210 Pages (7his line mutt be on fine h of Detailed Summary Page CRO -1100) $p o l CRO -1210 M->o_n_ h er.i ...i 11,vr, ,. April Amendment In -Kind Contributions Pg _ of _ ❑ ,es ❑ No Use this form to report non -monetary contributions, donati,,n,, goods or services provided to the committee or fund. Use CRO -1215 if In -Kind Contributions were or wil l be refunded within 7 days. 1. Committee'Full "Name (and Fund if applicable) :, 3. Contributor Information ❑ Add ❑ Remb 2. ID Number a. Full Name, Mailing Address & Phone (include city, state, & zip) rs�I O V� t��.e� Ji{( Ct_ f� �� ((� A// � f 3( `s/ v I `' l 111 b. Type of Contributor ❑ Individual Candidate B Party [3 PAC ❑ Referendum ❑ Other Receipt Source c. Continents Id. Elecdon Sam to Date $ C� e. Description C4111cilddit L Date (mmildd/yyyy) g. Fair Market Amount $ $ 3. Contributor Information ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Contributor ❑ Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source c. Comments d. Elecdon Som to Date $ e. Description L. Date (mm/dd/yyyy) g. Fair Market Amount $ $ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) pN GCUS .Pi,C� �,Hti1P('1C'1, F1N b. Type of Contributor Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source c. Comments it. Election Sam to Date $ u. 1)"Cription _ L Date(mm/dd/yyyy) g. Fair Market Amount $ $ 4. Total only this Page $ 5,0� 5. Total of ALL CRO -1510 Pages (This line must be on line 17 of Derailed Summary Page CRO -1100) $ Efj CRO -1510 NC Slate Board of Elections December 2007