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Gemignani,John_2025-35-DayAmendment -- --- Disclosure Report Cover I ❑ vea ® ., 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 FRAWRombfOrmation a. Full Name c. 11) Number JOHN G FOR WAXHAW 6JM77E b. Mailing Addresstinetade City, State and Zip Code) it. Date Feed 1112 RIDGEHAVEN RD WAXHAW, NC 28173 9/30/2025 c. Phone Number 704-575-0794 2. Report Year 3. Period Start Date (mm)dd,yy) mWd 4. Period End Date 5. Treasurer Full Name 2025 07/09/2025 09/23/2025 John Gemignani ,'b, Type of Committee (Check One) 9. Type of Report (check only one pe o re`ort om one cee gory) ® Candidate Campaign ❑ Party Municipal State/County Referendum ❑ PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational Independent ❑ Joint Fundraiser ❑ Expenditure ® Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ Pre-primary ❑ First ❑ Final ❑ "Booster Fond" ❑ Pre-election ❑ Second ❑ Supplemental Final ❑ Building Fond ❑ Pre -runoff ❑ Third ❑ Annual Semi-annual ❑ Fourth ❑ Special ❑ Mid Year Semi-annual ❑ Other: ❑ Year End ❑ Mid Year 10. Special Report Name ❑ Final ❑ special ❑ Year 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 Truist b. Purpose e. Account Code b. Pursa �, )U e. Account Code Candidate Committee 5075 —A1V h GN FINANCi__ SEP 3 0 2025 d. Period Regio Balance it. Period Begin Balance $ 287.91 RECEIVE[) 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 r o -disclosed funds. I further certify that this report is complete, true and correct and that I have been trained by the NC to oat o 'ons. . John Gemignani 09/302025 Printed Name of Signer gnature of App o t . reasurer Date FOR OFFICE USE ONLY 11 , q Date Received: Employee: ' 6#f D ive M t NormalWl ?Iff Date Postmarked: Employee: Re -Mail_ --- gtstered --�_-- H _-- Date Scanned: Employee: - Elee>rQttjc3tlg Q Si¢neerTtasFot - -- Date Data Entered: Employee: to Please Note: This form cannot be used to amend committee information such as the committee address, treas custodian of books information, or account information. You must amend the Statement of Organization (CRO-210OA-E) to make committee char es. CRO -1000 NC State Board of Elections LA t C Q a y v UL Amendment Detailed Summary ❑ Yes ® No Use this form to summarize all disclosure reporting forms and to total mone information. 1. Committee Full Name and Fund if applicable) 2. Type of Report John G for Waxhaw 35 -Day 6JM77E Start of Election Cycle: January 1, 2025 Total this Reporting Period Total this Election Cycle 4) 5) 6) 7) 8) 9) 10) 11) Cash on Hand at Start Aggregated Contributions from Individuals Contributions from Individuals Contributions from Political Party Committees Contributions from Other Political Committees Loan Proceeds Refunds/Reimbursements To the Committee Other Receipt Sources Ila) Interest on Bank Accounts llb) Contributions from Not -tor -Profit Organizations Ile) Outside Sources of Income lid) Legal Expense Fund – Other Sources 11 e) Exempt Purchase Price Sales (CRO -1205) (CRO -1210) (CRO -1220) (CRO -1230) (CRO -1410) (CRO -1240) (CRO -1250) (CRO -1250) (CRO -1250) (CRO -1270) (CRO -1165) S $ 287.91 100.00 $ $ S 2350.22 $ $ $ $ $ $ $ $ $ $ $ $ S $ $ $ $ $ $ 12) TOTAL RECEIPTS (Add litres 5, 6, 7, 8, 9, 10, Ila, Ilb. 11e. lid and Ile) $ $ 2450.22 1374.62 $ S 13) 14) 15) 16) 17) Disbursements 13a) Operating Expenditures 13b) Contributions to Candidates/Political Committees 13c) Coordinated Party Expenditures Aggregated Non -Media Expenditures Loan Repayments Refunds/Reimbursements From the Committee In -Kind Contributions (CRO -1310) (CRO -1310) (CRO -1310) (CRO -1315) (CRO -1420) (CRO -1320) (CRO -1510) $ $ S $ $ 121.71 $ $ $ $ $ $ 600.22 $ 18) TOTAL EXPENDITURES (Add lines 13o, 13b, I3c, 14, IJ, 16 and 17) $ 2096.55 $ 19) 20) 21) 22) 23) 24) 25) 26) 27) 28) Cash on Hand at End (Add lines 4 and 12 together, thea subtract fine 18) Non -Monetary Gifts Given to Other Committees (CRO -1330) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) Debts and Obligations owed By the Committee (CRO -1610) — Debts and Obligations owed To the Co L*01 l F I N A N C E(CRO- 1620) Account Transfers Within the Committee (cR04' Administrative Support C r nj(CRO-1710) Forgiven Loans RECEI V I, t- 60-1440) 48 -Hour Notice Reports Sum (CRO -2210) Contributions to be Refunded (CRO -1215) $ $ $ 641.58 $ $ $ $ $ $ $ $ 7- $ $ S $ CRO -1100 NC State Board of Elections August 2008 Amendment Aggregated Contributions from Individuals Page I or i ❑ Y" ® No Optional form used to report NC Contributions From Individuals of $50 or less vl1`.'. r]F,1�r •-•, anla�tFA ltcabW -.. ,.T ,.'.�9Tt:-? .:. . .. John G for Waxhaw 6JM77E a. Amend It. Account Code c. Form of Payment d. In -Kind Description c. Date mm/dd/ L Amount ® Add 0222 Stripe Contribution 08/23/2025 $ 50.00 ❑ Remove ® Add 0222 Stripe Contribution 08/26/2025 $ 50.00 ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ F-1Remove ❑ Add $ ❑ Remove ❑ Add UNION COUNTY AIGN FINANCE $ ❑ Remove ❑ Add I SEp 3 0 2025 $ ❑ Remove Add V E D $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove 4. Total only this Page $ 100.00 5. Total of ALL CRO -1205 Pages (This Rne mull be online 5 of Detailed Summary Page CRO -1100) $ 100.00 CRO -1205 NC State Board of Elections April 2007 Amendment Contributions from Individuals Pg I or 4 ❑ les ® No Use this form to report individual contributions over S5o w contributions under $50 if form CRO 1205 is not used L'Iff6anilluee Full Name (and Plaid If applicable) 2. ID Number JOHN G FOR WAXHAW 6JM77E 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) h .fob Tine/Profession it, Comments I Logistics Operations Team Yard Sign Committee to Elect Daniel Farris 4003 English Oaks Ct. Waxhaw, NC 28173 (704) 519-2444 c. Employer's Name/SpedOc Field Expressway Transportation e. Election Sum to Date $ 404.15 f. Prior g. Account Code It. Form of Payment 1. to-Kiod Description I. Date (mm/dd/yyyy) LAmount ❑ Team Sign Print 09/16/2025 $ 404.15 ❑ $ ❑ $ 3. Contributor Information ® Add ❑ Remove it, Fall Name, Mailing :Wdress&Phone (include city, state, & zip1 It. Job Tine/Profession d. Comments COO Contribution Michael Flood 2832 Egypt Valley Ave NE Ada, MI 49301 (817) 877-3991 c. Employer's Name/Specific Field Kodiak BP e. Election Sum to Date $ 100.00 f. Prior g. Account Code b. Form of Payment i. In-Kiad Description J. Date (mm/dd/yyyy) k. Amount ❑ 0222 Stripe 08/26/2025 $ 100.00 ❑ $ ❑ $ 3. Contributor Information Add ❑ Remove - a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Protessioo d. Comments Mail Carrier Bob Lisi 4700 Magnolia Ridge Dr UNION COUN Waxhaw, NC 28173 CA1 ^PAIGN FIN SEP 3 0 20 401nipioyer's Name/Specific Field USPS 5 e. Election sum to Date $ 100.00 f. Prior I g. Account Code It. Form of Pry n -Kind Deacription j. Date (mm/dd/yyyy) k. Amount ❑ 0222 Stripe 08/31/2025 $ 100.00 ❑ $ ❑ $ 4. Total only this Page $ 604.15 5. Total of ALL CRO -1210 Pages $ 2350.22 (This fine must he on fine 6 of Demited Su rmseuy Page CRD -1100) CRO -1210 VC Mate Board of L'Irctinn, April 2D07 %mendment Contributions from Individuals Pg 2 or 4 ❑ fes Use this form to report individual contributions over $50 or contributions wider S50 if form CRO 1205 is not used 1. Committee Fall Name (and Pi tf applicable) 2, tD Number JOHN Ci FOR WAXHAW 6JM77F. 3. Contributor Information ® Add ❑ Remove a. Full Name, flailing .Address & Phone (include city, state,&zip) b. Job Iille/Prole cion d. Comments Teacher Contribution Cathy Siliakus 2428 Surveyor General Dr Waxhaw, NC 28173 (704) 577-0996 c. Employer's Name/Specific Field e. Election Sum to Date $ 100.00 C Prior g. Account Code h. Form of Payment 1. In -Kind Description J. Date (mm/dd/yyyy) k. Amount. ❑ 0222 Stripe 09/17/2025 $ 100.00 ❑ 5 3. Contributor Information ® Add ❑ Remove a. Full Name, 'flailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Wellness Consultant Contribution Katherine Priebe 8008 Alma Blvd Waxhaw, NC 28173 (704) 297-5941 c. Employer's Name/Specific Field The Root Brands e. Election sum to Date $ 100.00 f. Prior g. Account Code h. Form of Payment I. In -Kind Description I. Date.(mm/dd/yyyy) k Amount ❑ 0222 Stripe 09/18/2025 $ 100.00 ❑ $ *-Vontributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) WTq b. Job Title/Profession d. Comments Sales Contribution Daniel Scallion utiIONFINAN 8208 Penman Springs dr CAMPAIG td CE Waxhaw, NC 28173 SEP 3 p Zp25 (586) 612-2634 RECENED a Employer's Name/Speeific Field Hendrick Automotive e. Election Sum to Date _ $ 100.00 E Prior it. Account Code It. Form of Payment I. In -Kind Description. j. Date (mm/dd/yyyy) k. Amount ❑ 0222 Stripe 09/22/2025 $ 100.00 ❑ $ ❑ $ -- 4. UtRonly this Page $ 300.00 5. Total of ALL CRO -1210 Pages $ 2350.22 (This line nwsr be on line 6 of'Derailed Sumnwn- Page CRO-! 100) CRO -1210 NC State board of Flections April 2007 \ni end III ent Contributions from Individuals Pg 3 of i ❑ ❑ N', Use this form to report individual contributions over $50 of contributions under $50 if form CRO 1205 is not used 1 Committee Full Name (and' Fund if applicable) 2. tD Number ,101 IN (i I ()R N.SXHAW 6JM77E. 3. Contributor Information ❑ Add ❑ Remove a. Full Name. }tailing Udress & Phone (include city, state, & zip) b. Job Title/1'rofession d. Comments Police Officer Lawson Meet & Greet Errol Wedra 4344 Oxford Mill Rd Waxhaw, NC 28173 c. Employer's Name/Specific Field City of Mint Hill e. Election Sum to Date $ 235.40 f. Prior g. Account Code Is. Form of Payment I. to -Kind Description J. Date (mm/dd/yyyy) L Amount ❑ Event Space 9/17/2025 $ 67.00 ❑ Refreshment 9/17/2025 $ 15.00 ❑ Literature 9/17/2025 $ ^_3.40 3. Contributor Information Add ❑ Remove a. Full Name,'llailing Address & Phone (include city, smte. & rip) b. Job Title/Profession d. Comments Homemaker Inverness on Providence Meet & Greet _ Susan Marciniak 113 Somerled Way Waxhaw, NC 28173 (954) 415-9498 c. Employees Name/Specific Field e. Election sum to Date $ 206.67 1'. Prior g. Account Code h. Form of Payment I. In -Kind Description J. Date (mm/dd/yyyy) k Amount ❑ Event Space 09/19/2025 $ 41.67 ❑ Refreshments 09/19/2025 $ 15.00 ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Fall Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Logistics Operations Contribution Committee to Elect Michael De Itdi9ty 3402 Taviston Dr. -"IG ETNA Waxhaw, NC 28173Q 2 25 (901) 573-1996 SEP 3 CEi\1EG c. Employer's Name/Specific Field FedEx e. Election Sum to Date $ 34.00 C Prior g. Account Code 11. Form of Payment 1. In -Kind Description j. Date (mm/dd/yyyy) it. Amount ❑ Booth Rental 09/23/2025 $ 25.00 ❑ Printing 09/23/2025 $ 9.00 ❑ $ 4. Total only this Page I $ 196.07 5. Total of ALL CRO -1210 Pages $ 2350.22 (This fine mast he on line 6 of Detailed Sununan' Page CRO -1 110) CRO- 12 10 SC State Board of Elections April 2007 Amendment Contributions from Individuals Pg 4 of 4 ❑ les ® NO Use this form to report individual contributions over $50 or contributions under $50 if firm CRO 1305 is not used 1. Committee Full Name (and Fund if applicable) 2. ID Number JOHN G PON blAAHAWA 6.IM77E 3. Contributor Information ® Add ❑ Remove a. Full Name, Ntailine AJdre<s & Phone (include city, state, &zip) b. Job Title/Profession J. Comments Sales Contribution John Gemignani 1112 Ridge Haven Rd. Waxhaw, NC 28173 (704) 575-0794 c. Employer's Name/Specific Field DPI Panels, LLC e. Election Sum to Date $ E Prior. & Account Code a. Form of Payment i. In -Kind Description 1. Date (mm/dd/yyyy) it. Amount ❑ Cash 09/03/2025 $ 550.00 ❑ Cash — 09/08/2025 $ 400.00 ❑ S 3. Contributor Ioformafiod ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Connnents Law Enforcement Officer Contribution _ Jorge & Ingrid Oberon c. Employer's Name/Specific Field - NYPD e. Election Sum to Date $ 300.00 L Prior g. Account Code h. Form of Payment 1. In -Kind Description J. Date (mm/dd/yyyy) L Amount ❑ Stripe 07/06/2025 $ 300.00 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state & zip) b. Job Title/Profession it. Comments UNIONOOFINANCI- CAMPAIGN SEP 3 0 2025 c. Employer'sName/SpecilleField e. Election Sum to Date $ f. Prior g. Account rm of Payment 1. In-IGnd Description J. Date (mWdd/yyyy) k Amount ❑ $ ❑ $ ❑ $ 4. Total only this Page $ 1250.00 5. Total of ALL CRO -1210 Pages $ 2350.22 (This line mast be on 6ae 6 ofDemUed Sunonaty Page CRO -1100) CRO -11111 Sl slate Beard of I'I lmns April 2007 Amendment Disbursements Pg I of 2 ❑ Yes ❑ No Use this form to report expenditures from the committee for: operating expenses, contributions to candidate/political committees and coordinated arty expenditures. 1. Committee Full Name (and Fund if applicable) 2. ID Number John G for Waxhaw 6.IM77C 3. Type of Disbursement Please use separate CRO -1310 fonmy for each type of Dlsbarsemel1. ® Operating I_cpen.es ❑ t nntribuunn,N to CandiJalc. Pohtieal Conuniuce, ❑ Coordinated Party G.cpend tures 4. Payee Information Add Ll Remove a. Full Name. Mailing Address & Phone include city, state & zip) b. ( oordinated Committee Name d. ('onvnents 5 x 7 Postcards GotPrint.com 7651 N. San Fernando Rd. Burbank, CA 91505 (818) 252-3000 c. Level Registered (Specify) Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 485,53 f. Account Code g. Form of Payment h. Purpose Code [.Date (mm/dd/yyyy) j. Amount it. Required Remarks 5075 Debit B 08!25/2025 $254.44 The Waxhaw Wall 5 x 7 Postcards 5075 Debit B 09/09/2025 $231.09 The Waxhaw Wall 5 x 7 Postcards 4. Payee Information ❑ Add Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments GotPrint.com 7651 N. San Fernando Rd. Burbank, CA 91505 (818) 252-3000 c. Level Registered (Specify) Federal ❑ County: ❑ State ® Municipality: a Elation Sum to Date $ 618.26 L Account Code g. Form of Payment b. Purpose Code i. Date (mm/dd/yyyy) J. Amount L Required Remarks 5075 Debit B 08/09/2025 $132.73 ThewaxhawWall Business Cards 4. Payee information Z Add Aemove a. Full Name, Mailing Address & Phone Include city, state, & zip) h. Coordinated Committee Name d. Comments Signs.com 8000 Haskell Ave UNIOI\I C-A)Ui + l Van Nuys, CA 91406 CAMPAIGN FINANCE 801.441.3400 SEP 3 0 2025 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Elation Sum to Date $ 618.36 f. Account Code g. Form of Psmek 1. Date (mm/ddlyyyy) J. Amount L Required Remarks. 5075 Debit B 09/04/2025 $618.36 JohnGforWaxhaw Campaign signs $ 5, Total only this Pae $ 1236.62 6. Total of ALL CRO -1310 Pages (This fine goes in line i.ta of Derailed Sunmmr Page CRO -1100 if Operating Expenses) (This fine goes in line 136 of Detailed Summar• Page CRO -1100 ifContrib to Candidates/Poadcal Conon) (This line goes in line 13c of Detailed Summon• Page CRO -11001f Coordinated Parry Expenditures) $ 1374.62 7. Pur' ose 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 *.C94ea.r uire detailed explanation in required remarks field k CR0-1310 NC State Board of Elections December 2009 Amendment Disbursements Pg j of 2 ❑ Yes ® No 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) umber John G Cur W'axham 6JM77f' 3. Type of Disbursement ease use separateCRO-1310 forms for each type of D1s arseme . ® l Jperaiin_ 1\penses ❑ loordinated fart+ li.cpendamcs 4. Payee Information 0 Add Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments Pressed For You LLC 4052 Deep River Way Waxhaw, NC 28173 (321) 432-2667 c. Level Registered (Specify) ❑ Federal County: ❑ State ® Municipality: e. Election Sum to Date $ 138.00 E Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) J. Amount L Required Remarks 5075 Debit B 09/04/2025 $138.00 _ The Waxhaw Wall T -Shirts 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. Election Sum to Date E Account Code g. Form of Payment Is. Purpose Code L Date (mm/dd/yyyy) J. Amount L Required Remarks. 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing .address & Phone include city, state & zipj b. Coordinated Committee Name d. Cum ments UNION GOUN I Y OAAIPAIGN FINANCE SEP 3 0 2025 a Level Registered (Specify) ❑ Federal ❑ County: ❑ State El Municipality: e. Election Sum to Date $ f. Account Code g. Form of P' I. Date (mtul"my) J. Amount k. Required Remarks $ $ 5. Total only this Pae $ 138.00 6. Total of ALL CRO -1310 Pages (phis line goes in line I-ia qt Derailed Summan Page CRO -11001f Operaling Expenses) (This line goes in line 13b of Detailed Summar• Page CRO -1100 if Contrib to Candidates/Poudcal Comm) $ 1374.62 (This line goes in line 13c of Derailed Summary Page CRO -1100 if Coordinated Party Expenditures) 7. Purpose Cedes ist detailed expenditure code in .) above) A* - Media B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Party H* - 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 -/310 NC State Board of Elections December 2009 Aggregated Non -Media Expenditures Page - of 1 Amendment Yes [ No Optional form used to re rt NC Non -Media Expenditures of $50 or less. 1. Committee Fuji Name7a= un app ca e r John G for Waxhaw 6JM77E 3. Payee Information . Amend It. Account Code t Form or Payment d. Purpose Code e. Date (mm/dd/yyyy) 4 Amount g. Required Remarb - -- ❑ Add ❑ Remove K .. ---- 07/15/2025 - $ 32 Campaign Website Hosting --- 5075 --------. Debit Add 5075 Debit K 08/15/2025 $ 32 Campaign Website Hosting ❑ Remove Er—Add C] Remove 5075 Debit K 09/15/2025 $ 32 Campaign Website Hosting Add ❑ Remove 0222 Stripe O 08/23/2025 $ 1.75 Credit Card Processing Fee Ll Add ❑ Remove 0222 Stripe O 07/06/2025 $ 9.00 Credit Card Processing Fee Add ❑ Remove 0222 Stripe O 08/26/2025 $ 3.29 Credit Card Processing Fee Ada ❑ Remove 0222 Stripe O 08/26/2025 $ 1.80 Credit Card Processing Fee Add 0222 Stripe O 09/17/2025 $ 3.29 Credit Card Processing Fee ❑ Remove Add ❑ Remove 0222 Stripe O 09/182025 $ 3.29 Credit Card Processing Fee —Add ❑ Remove 0222 Stripe O 09/23/2025 $ 3.29 Credit Card Processing Fee Add $ ❑ Remove ff Add— ❑D Remove Add $ [I Remove Add $ ❑ Remove Add $ ❑ Remove Add— Remove, ❑ Remove C NTY Lj Add GAMPAIG $ ❑ Remove Add S 2-95$ ❑ Remove ❑ Add REC $ ❑ Remove Add $ ❑ Remove 4. Total only this Page $121.71 5. Total of ALL CRO -1315 Pages $121.71 This line must be on line 14 of Detailed Summ Pa a CRO -1100) 6. Purpose Codes (List detailed expenditure code in (d) above) 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* - Donations to Legal Expense Fund O* -Other * Codes require detailed ex lanation in reouired remarks Feld CRO -1315 NC Smte Board of Elections December 2009 Amendment In -Kind Contributions Pg ! of ❑ Yea ® No Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund. use L KU -121 ` 11 In -Nino uomri Dutlons were or wm oe rellID[2u ks mini / udYs. 1. Committee FuR Name (and Fund if applicable) 2. ID Number JOHN G FOR WAXHAW 6JM77F: a. I oil Name, Mailing Address & Phone (include city, state, & zip) Errol Wedra 4344 Oxford Mill Rd. Waxhaw, NC 28173 (516) 906-1384 Event Space Literature 3:Contributor Wil t M -a fft a. Full Name, Mailing Address & Phone (include city. state, & zip) Susan Marcimak 113 Somerled Way Waxhaw, NC 28173 (954)415-9498 e. uescnpnon Event Space Refreshments 3. Contributor Information a. Fill Name, Mailing Address & Phone (include city, state, & zip) Committee to Elect Michael De lulio 3402 Taviston Dr. Waxhaw, NC 28173 (901)573-1996 ara I Printing FINAN( SEP 3 0 2025 ;ECEIVED b. Type of Contributor ® Individual ❑ Candidate ❑ Part ❑ PAC ❑ Referendum ❑ Other Receipt Source E Date (mm/dd/yyy 9/17/2025 9/17/2025 917/2025 h. Type of Contributor ® Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ other Receipt Source E 09/19/2025 09/19/2025 b. Type of Contributor ❑ Individual ❑ Candidate ❑ Ply ❑ PAC ❑ Referendum ❑ Other Receipt Source f. fate (mmldillyyy 09/23/2025 ,rI7P#IrII➢.F c. Comments Lawson Meet & Greet it. Election Som to Date $ 235.40 g. Fair Market. $ 67.00 $ 15.00 S 2:.40 c. Comments Inverness on Providence Meet & Greet d. Election Sum to Date $ 206.67 F) g. Fair Market Amount $ 41.67 S 15.00 S c. Comments Contribution d. Election Sum to Date $ 34.00 g. Fair Market Amount $ 25.00 $ 9.00 $ 4. Total only this Page D tYCIAI/ 5. Total of ALL CRO -1510 Pages (This fine must be on 6ne 17 of Detailed Summon, Page CRO -1100) $ 600.22 ERO-1510 NC State Board of Elections December 200 Amendment In -Kind Contributions Pg b of ❑ Yea ® 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 relimded within 7 daNs. 1. ConlrilIM6 Full Name (and Fund if applicable) 2. to Number JOHN G FOR ikAXHAW 6JM77E 3. Contributor Information Add Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b.'rype of Contributor e. Comments ❑ Individual ® Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source Team Yard Sign Committee to Elect Daniel Farris 4003 English Oaks Ct. Waxhaw, NC 28173 (704) 519-2444 d. Election Sum to Date $ 404.15 C. Description - f. Date (mm/ddlyyyy) g. Fair Market Amount Team Sign Print 09/16/2025 $ 404.15 $ 3. Contributor Information Add Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b.'Fvpe of Contributor c. Comments ❑ Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source d. Election Sum to Date $ e. Description f. Date (mm/dd/yyyy) g. Fair Market Amount 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state. & zip) b. Type of Contributor c. Comments ❑ Individual ❑ Candidate ❑ Ply ❑ PAC ❑ Referendum E] Other Receipt Source ,I COUNTY AIGN FINANCE SEP 3 0 2025 RR L' d. Election Sum to Date $ e. Description 9' C Date (mm/dd/yyyy) g. Fair Market Amount $ 4. Total only this Pae $ 404.15 5. Total of ALL CRO -1510 Pages S 600.22 (This line mast be on line 17 of Detailed Summa" Page CRO -1100) CRO -1510 NC State Board of Elections December 2007