Simpson,Anne_2023-35-DayAmendment
Disclosure Report Cover ❑ Yes ® 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 update information
1. Committee Information
a. Full Name
c. ID Number
Anne M. Simpson for Commisioner
LJMJOX
b. Mailing Address (include City, State and Zip Code)
d. Date Filed
2517 Trading Ford Dr
9/29/2023
Waxhaw NC 28173
e. Phone Number
704-256-4976
2. Report Year
3. Period Start Date (mmidd/yy)
mPPeriod End Date
5. Treasurer Full Name
Anne Marie Simpson
2023
07/01/2023
09/26/2023
6. Type of Committee Check One
9. Type
of Re rt check only
one e o re ort
om one category)
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
❑
Organizational
❑ Organisational
❑ Organisational
Independent Joint FundraiserThi
El Expenditure ❑
®
five
r�'- day
Quarterly❑
Pre -referendum
❑ Legal Expense Fund
❑
❑
Pre-primary
Pre-election
❑ First
❑ Second
❑ Final
❑ Supplemental Final
7. Type of Fund (fappfi-bre, check one)
❑ 'Booster Fund"
❑ Building Fond
❑
Pre -runoff
❑ Third
❑ Annual
Semi-annual
❑ Fourth
❑ Special
❑
Mid Yew
Semi-annual
❑ Other:
❑
Year End
❑ Mid. Yew
10. Special Report Name
❑
❑
Final
special
❑ Yew End
❑ Final
❑ Special
8. Number of Fundraisers this Report
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
Wells Fargo
b. Purpose
a Account Code
b. Purpose
o Account Code
Campaign
4WXW
- C E I V E D
Finance
t t_
d. Period Begin Balance
d. Period Begin Balance
Activities
r,!7P 2 9 2023
r
$ 2000.00
$
CERTIFICATION
I certify that the Committee or Fund is in compliance with
all applicable provisions of Article 22A, 2211, & 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 S? B d of Elections.
Anne Marie Simpson
t-( . 9/29/2023
Printed Name of Signer
Signature of Appointed Treasurer
Date
FOR OFFICE USE ONLY
Date Received: �9 3
Employee: Delivery Method
❑ Normal Mail
Q Registered Mail
Date Postmarked:
Employee:
[Ell Hand Delivered
/� /��,/�///��
E] Electronically Filed
Date Scanned: /i7
''
Employee:
❑ Signer has not received
`{
mandatory training
Date Data Entered:
Employee:
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.
CRD -1000 NC State Board of Elections August 2008
Amendment
Detailed Summary ❑ Yes ® No
Use this form to summarize all disclosure reporting forms and to total monetary information.
1. Committee Full Name and Fund if applicable)
2. T
of Report
3. ID Number
Anne M. Simpson for Commissioner
35 -Day
LIMJOX
Start of Election Cycle: January 1, 2023
Total this
Reporting Period
Total this
Election Cycle
4)
Cash on Hand at Start
$
2000.00
$
2000.00
Lei
5) Aggregated Contributions from Individuals
6) Contributions from Individuals
7) Contributions from Political Party Committees
8) Contributions from Other Political Committees
9) Loan Proceeds
10) Refunds/Reimbursements To the Committee
11) Other Receipt Sources
Ila) Interest on Bank Accounts
l lb) Contributions from Not -for -Profit Organizations
Ile) Outside Sources of Income
lld) Legal Expense Fund — Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CR&1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
$
$
$ $
5.00
$ $
$ $
$ $
2000.00
$ $
$ $
$ $
$ $
$ $
$ $
12)
TOTAL RECEIPTS (Addlines5, 6, 7, 8, 9, 10, Ila, 1Ib, 11c, lldand lie)
$
$
2005.00
13)
14)
15)
16)
17)
E-,
Disbursements
13a) Operating Expenditures (CRO -1310)
13b) Contributions to Candidates/Political Committees (CRO -1310)
13c) Coordinated Party Expendit (; E i V E D (CRO -1310)
Aggregated Non -Media Expenditures SEP 2 921123 (CRO -1315)
Loan Repayments (CRO -1410)
Refunds/Reimbursements From of E1e01011S (CRO -1310)
In -Kind Contributions (CRO -1510)
S
1859.20
$
1859.20
$ $
$ $
$ $
$ $
$ $
$ $
5.00
18)
TOTAL EXPENDITURES (Add lines 13a 13b, 13c, 14. 1 s. 16 and 17)
$
1859.20
$
1864.20
19)
Cash on Hand at End (Add lines 4 and 11 together, then subtract line 18)
$
140.80
S
140.80
20)
21)
22)
23)
24)
25)
26)
27)
28)
Non -Monetary Gifts Given to Other Committees
Outstanding Loans (incl. ones from other campaigns)
Debts and Obligations owed By the Committee
Debts and Obligations owed To the Committee
Account Transfers Within the Committee
Administrative Support
Forgiven Loans
48 -Hour Notice Reports Sum
Contributions to be Refunded
(CRO -1330)
(CRO -1430)
(CRO -1610)
(CRO -1620)
(CRO -1720)
(CRO -1710)
(CRO -1440)
(CRO -2220)
(CRO -1215)
$
$ 2000.00
$
$
$
$ $
$ S
$ $
$ $
CRO -1100 NC State Board of Elections August 2008
Amendment
Disbursements Pg 1 of 2 ❑ Yes ® ]n
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
committees and coordinated party expenditures.
1. Committee Full Name and Fund if applicable) 2. ID Number
Anne M. Simpson for Commissioner I LJMJOX
3. T of Disbursement Please use separate CRO -1310 forlm for each type of Disbursement
® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures
4. Payee Information Add El Remove
a. Full Name, Mailing Address & Phone
include city, state, & a
b. Coordinated Committee Name
d. Comments
e. Election Sum to Date
$ 12.00
Google LLC
1600 Amphitheatre Pkwy
Mountain View Ca 9404
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
L Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
4WXW
Debit
A
07/11/2023
$12.00
Website Domain
$
4. Payee Information Add El Remove
a. Full Name, Mailing Address & Phone
include city, state, & zip)
b. Coordinated Committee Name
d. Comments
Vistaprint / G-
275 Wyman Street �_ I " L— D
Waltham MA 02451 y' }
866-207-4955 SEP 2
,anion Co. Bea t :;'Ions
c. Level Registered (Specify)
E]Federal ❑ County:
❑ State ® Municipality:
t. Election Sum to Date
$ 1039.41
f. Account Code
g. Form of Payment
Is. Purpose Code
L Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
4WXW
Debit
B
07/31/2023
$1039.41
Doorhangers
4. Payee Information R Add Remove
a. Full Name, Mailing Address & Phone
include city, state, & zip)
b. Coordinated Committee Name
d. Comments
Post Boost
Promotion
Meta Ads
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sum to Date
$ 50.00
E Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm)dd/yyyy)
j. Amount
L Required Remarks
4WXW
Debit
A
09/17/2023
$25,00
Website
Promotion
4WXW
Debit
A
09/21/2023
$25.00
Post Boost
5. Total only this Pae
$ 1101.41
6. Total of ALL CRO -1310 Pages
(This line goes, in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses)
(This lingoes in line 13b of Detailed Sumnany Page CRO -1100 if Contrib to Candidates/PoliGeal Comm)
(Thu• One goes in line He of Detailed Summary Page CRO -1 1001fCoordinated Parry Erpendrtures)
$ 1859.20
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 PamH* - Holding Public Office Expenses
1 - Postage J - Penalties K* -Office Expenses Q* - Donation to Legal Expense Fund
O* - Other
* Codes require detailed explanation in required remarks field (k)
CRO -1310 NC State Board of Elections December 2009
Amendment
Disbursements Pg z of z ❑ ve.s ❑ N..
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
committees and coordinated party expenditures.
1. Committee Full Name and Fund if applicable) 2. ID Number
Anne M. Simpson for Commissioner IJM)OX
3. Type of Disbursement Please use separate CRO -1310 fornas for each type of Disbursement
® Operatin, Expenses ❑ C'ontnbutiuns to Cmdidatcs/Political Committees ❑ Coordinated Party Expenditures
4. Payee Information Z Add Remove
a. Fall Name, Mailing Address & Phone
include city, smtq & zip)
b. Coordinated Committee Name
d. Comments
Yard Signs
Signs.Com
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sum to Date
$ 757.79
L Account Code
g. Form of Payment
b. Purpose Code
i. Date (mm/ddlyyyy)
J. Amount
k. Required Remarks
4WXW
Debit
B
09/11/2023
$757.79
Yard Signs
$
4. Payee Information Add Remove
a. Full Nsme, Mailing Address & Phone
include city, state, & zip)
b. Coordinated Committee Name
d. Comments
RECEIVED
SEP 2 9 2023
Union Co. Board of ElectionS
e. Level Registered (Spew)
E] Federal El County
❑ State ❑ Municipality:
e. Election Sum to Date
$
E Account Code
g. Form of Payment
It. Purpose Code
L Date (mm/ddlyyyy)
j. Amount
k. Required Remarks
$
4. Payee Information Add Remove
a. Full Name, Mailing .Address & Phone
include city, state, & zip)
b. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality:
e. Elation Sum to Date
E Account Code
g. Form of Payment
It. Purpose Code
L Date (mm/ddlyyyy)
j. Amount
k. Required Remarks
$
$
5. Total only this Pae
$ 757.79
6. Total of ALL CRO -1310 Pages
(Thio line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses)
(Thio fine goes in line 13b of Detailed Summary Page CRO -1100 ifContrib to Candidates/Polideai Comm)
(This line goes in fine 13c of Detailed Sum zurr Page CRO -1100 if Coordinated Party Expenditures)
$ 1859.20
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 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 k
CRO -1310 NC State Board of Elections December 2009
Amendment
Outstanding Loans Pg 1 of 1 ❑ Yes ® No
Use this form to report any outstanding loans received during a previous reporting period and until the loan is paid in full.
1. Committee Full Name and Fund if applicable) 2. ID Number
Anne M. Simpson for Commissioner LJMJOX
3. Lender information Z Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, xls% & zip)
b. Job Title/Profession
d. Comments
Registered Neuse
Anne M. Simpson
2517 Trading Ford Dr.
Waxhaw NC 28173
e. Start Date (mm/ddyyyy)
c. Employer's Name/Specific Field
07/05/2023
Novant Health
E End Date (mm/ddyyyy)
g. Rate
h. Security Pledged
i. original Loan Amount
j. Remaining Loan Balance
0 %
$ 2000.00
$ 2000.00
it. Full Name of Lending Institution
1. Loan Number
3. Lender Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job'ritle/Profession
d. Comments
e. Start Date (mm/ddyyyy)
c. Employer's Name/Specific Field
L End Date (mm/ddyyyy)
g. Rate
It. Security Pledged
i. Original Loan Amount
j. Remaining Lose Balsam
$
$
it. Full Name of Lending Institution
1. Loan Number
3. Lender Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, &zip)
b. Job Title/Profession
d. Comments
e. Start Date (mm/dd/yyyy)
c. Employer's Name/Specific Field
L End Date (mm/dd/yyyy)
g. Rate
h. Security Pledged ::Ti-106:090nal
Loan Amoont
J. Remaining Loan Balaam
$
$
L Full Name of Lending Institution
1. Loan Number
4. Total only this Pae
$ 2000.00
5. Total of ALL CRO -1430 Pages
(This fine neat he on fine 21 of Detailed Summary 0) Page CRO410
$ 2000.00
CRO -1430 NC State Board of Elections December 2007