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Smith,Thomas_2023-OrgReportndanient Disclosure Report Cover Yet 0 No Use this form for general report and committee information, must be signed and submitted along with other detailed forms. Do not use this fomt to update information. 1. Committee Information . Full Name c. ID Numher -H i 1!S{1iV'/� . Mailing Address (include City, Statand Zip Code). -77w-L d. Date Filed IT r7 C_'_ V_ CT li 2,6 rk--'—tt C4 N C L !( /,) v e. hone Nfinber 'i 2. Report Year 3. Period Start Date (mmfdd/yy) 4. Period End Date (nun/ddlyy) 15. TreasurerFull Name 7 107 Z/ s—/" 6 ype of Committ (Check Crop) ` 9. Type df Rep t (c ck only one type of report front one category) Candidmc Cnmpuign ❑ Party Municipal State/County Referendum PAC ❑ ReferendumOrganizational Organizational E]E]Organizational E3Independent Expenditure El Joint Fundraiser L3 Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Pond ❑ Pre-primary ❑ Fra ❑ Final ❑ Preelection ❑ Pre -runoff ❑ Second ❑ Third ❑ Supplemental Final ❑ Annual =Type_bfFund(ii(applicable. check -one) ' ❑ Ba,smr Fund Semi-annual ❑ Fourth ❑ Special ❑ Building Fund ❑ Mid Year Semi-annual ❑ Year End ❑ Mid Year 10. Special Report Name ❑ Other. ❑ Final ❑ special ❑ YearEnd ❑ Final S,_Number_of fundraisers this Report - - - FD ❑ Special 1 tion 11. Account Information . Financial Institution Full Name a. Financial Institution Full Name � b.Tri c. AccountCode h. Purpaw c. Account Code /Purpose G �iu I'142 -'Z d. Period Begin Balance d. Period Begin Balance $ b $ 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 this report is complete, true and correct and thathave been trained by the NC State Board o�f Elections.. 'I printed Name of Si mer Si nature ofAppoialed Treasurer Da FOR OFFICE USE ONLY 7 Date Received: c� Employee: Delivery Method t, ❑ Normal Mail Date Postmarked: Employee: Registered Mail Hand Delivered Date Scanned: Employee: Electronically Filed Date Data Entered: Employee: E3 Signer has not received mandato tratnin 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. CK(1-luau NC State Board of Elections August 2008 Amendment Detailed Summary ❑ Yes ❑ No Use this form to summarize all disclosure renortin2 forms and to total monetary information 1. Committee Full Name (and Fund if applicable) /✓, ti %)G LoIM 2. Type of Report v.��6,�.I l � ���� 3. ID Number zL � i� Start of Election Cycle: January 1, 70 Total this Reporting Period Total this Election Cycle 4) Cash on Hand at Start $ $ RECEIPTS 5) Aggregated Contributions from Individuals (CRO -1205) $ $ 6) Contributions from Individuals (CRO -1210) $ D �. U o $ 7) Contributions from Political Party Committees (CRO -1220) $ $ 8) Contributions from Other Political Committees (CRO -1230) $ $ 9) Loan Proceeds 10) Refunds/Reimbursements to the Committee 11) Other Receipt Sources (CRO -1410) (CRO -1240) $ $ $ $ Ila) Interest on Bank Accounts (CRO -1250) $ $ 11b) Contributions from Not -For -Profit Organizations (CRO -1250) $ $ 11c) Outside Sources of Income lid) Legal Expense Fund - Other Sources Ile) Exempt Purchase Price Sales (CRO -1250) (CRO -1270) (CRO -1265) $ $ $ $ $ $ 12)TOTAL RECEIPTS (Add lines 5,6. 7,8,9, 10,1 la, l l b, l l c, l l d and l le) $ $ 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 (CRO -1320) $ $ 17) In -Kind Contributions (CRO -1510) $ 0 $ 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ U e-) $ 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18 $ 100,o 0 $ ADDITIONAL INFORMATION 0) Non -Monetary Gifts Given to Other Committees (CRO -1330) $ $ $ $ __9 1) Outstanding Loans (Incl. ones from other campaigns) (CRO -1430) 2) Debts and Obligations owed by the Committee (CRO -1670) 23) Debts and Obligations owed to the Comdilt"N COU 1620) jor ) Account Transfers Within the Committee ex0.1720) $ 25) Administrative Support Jul (60-1710) $ $ 26) Forgiven Loans E0"0) $ $ 7) 48 -Hour Notice Reports Sum (CRO -2220) $ $ $ $ 8) Contributions to be Refunded (CRO -1215) CAU -1100 NL: state Board of elections August 2008 Amendment Contributions from Individuals Pg _ of _ ❑ Yes ❑ No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used "UMMMA&Mme anal'tnd if a" Kati SWI fl, y tz) �- O 2 1'r P < GS nn PH F 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (Include city, state, & zip) b. Job Tiue/Profession d. Comments 5 7 ml 2 f • !8�l0 -�� t', IGli G M' -Wtl wS G 2�Icy C. Employer's NamelSpeciOc Field M er' aq- (M g (� y J e. Election Sum to Date I$ /0�, u� . Prior ❑ g. Account Code h. Form of Payment i. In -Kind Description j -.-Date (mm/ddlyyyy) 711 7 7,,,13 k Amount (vi m8 $ St v D ❑ T «+.A -F; ,, 7110 ZoZ3 $ 100-00 3. Contributor Information ❑ Add ❑ Remo ,__._. _ -_ a. Full Name, Mailing Address & Phone (indude city, state, & zip) b. Job Title/Profesion d. Comments e. Employer's Name/Specific Field e. Election Sum to Date $ f. Prior g. Account Code It. Form of Payment i. In -Kind Description J. Date (mmtddlyyyy) k Amount ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, flailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments c. Employer's Name/Specific Field e. Election Sum to Date $ f.Prior ❑ g. Account Code h. Form of Paymeof' -Kind Description J. Date (mmldd/yyyy) k Amount $ ❑ $ 4. Total only this Page 5. Total of ALL CRO -1210 Pages (This line must be on liue! of Ue(niled J7�mmm�• Page CRO -1100) $ CRO -1210 A( 1:,' Ri •:mi ofElceuum April 2007 Amendment In -Kind Contributions Pg_ of _ ❑ Yes ❑ No Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund. Use CRO -1215 if In -Kind Contributions were or will be refunded within 7 days. 1. Committee Full Name (and Fund if applicable) 2. ED Number`_"" ` 3. Contributor Informatio$ _ _ ❑ Add ❑ Remove a. Full Name. \tailing Address & Phone b. TN pe of Cut ributnr c. (lnnnienl. (Include city, state, & zip) _ _ —[�1%� , S ❑ Individual Candidate �/� �� 1 / " G' ' /' ,j, ,rt f O Ll /� 5 �1.� Y ` Q4r ❑ Party ❑ PAC Y tom- CAJS G 2 G / /1 \', ❑ Referendum d. Election Sum to Date 0 l it r ❑ Other Receipt Source e. Description L Date (mmtddtyyyy) g, Fair Market Amount 7 UZ $ S-. v $ $ 3. Contiibutor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone b. Type of Contributor c Comments (include city, state, &zip) ❑ Individoal ❑ Candidate ❑ Party ❑ PAC ❑ Referendum d. Election Sam to Date ❑ Other Receipt Source $ e. Description L Date (mmlddlyyyy) g. Fair Market Amount $ $ 3. Contributor Information ❑ Add ❑ Remove . Full Name, Mailing Address & Phone b. Type of Contributor c. Comments (include city, state, & zip) Mra ividual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum d. Election Sum to Date ❑ Other Receipt Source $ . Description talAiliG� L Date (mmfdd/yyyy) - - -- - - - — _ R. Fair Market Amount $ .1 $ 4. Total only this Page $ t O 5. Total of ALL CRO -1510 Pages ' :, $ (This line must be on line 17 of Detailed Summary Page CRO -1100) CKU-1.110 NC State Board of Elections December 2007