Jones,Clayton_2025-PreElections-AmendmentsDisclosure Report Cover Amen es ent O No
Use this form for general report and committee information, must be signed and submitted along with other detailed forms.
Do nut use this form to update information.
1. Comm ttee Information
a. full \anti
w Cif r , v /c,
C. 11) .\umber
b. Mailing dress (include City, State and Zip CodeY
d. Date Filed
e. Phone Number
Gva X �14oJ � O
—
2. Report Year
3. Period Start Date (nuo/dd y
4. Period End Date mm/d&
5. Treasurer Full Name
/012G/25/.t
fon/ (�¢ JJA:Fs"
G, Type of Committee Check One)
lM Cmdidate Campaign ❑ Fall.,
9. Ty a of Report (ceck
only one 4_Pa of rep
tfrorn one category)
Municipal
State/County
_
Referendum
❑ PAC ❑ Referendum
❑ Organizational
❑ Organizational
❑ Organizational
❑ Independent Expenditure ❑ Joint Fundraiser
❑ Thirty-five day
Quarterly
❑ Pre -referendum
❑ I.zgal Expense Fund
❑ Pre-primary
❑ First
❑ Final
® Pre-election
❑ Pre -runoff
❑ Second
❑ Third
❑ Supplemental Final
❑ Annual
7. Type of Fond (if opplicable, cheek one)
❑ Booster Fund
Semi-annual
❑ Fourth
❑ Special
❑ Building Fund
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
10. Special Report Name
❑ Othcr
❑ Final
❑ Special
❑ Year End
❑ Final
8. Number of Fundraisers this Report
❑ Special
11. Account Information
11. Account Information
a. Financial Institution Full Name
S- /4 e ctny /� eas' CieC/, f O t/;.,r
a. Financial Institution Full Name
Sv, �4 Sf,�7�
b. Purpose
, h.11s
�y
c. Account Code
til
b. Purpose
c. Account Code
OX �5, � �/��.t��r�
f /, h z��S
� - ---
d. Period Begin Balance
d. Period Begin Balance
$
$ S pU.oa
CERTIFICATION yy, s—
I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 2213-22M of Chapter 16;
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.
rt2 5'
c /c 1.Td� dee %u vPs i/�o �2. o
Printed Name of Signer Wriature of A ointed reasurer I x'.
FOR OFFICE USE ONLY
Dale Received: I Employee: Delivery Method
as
❑ Normal Mail
Date Postmarked: Employee: Registered Mail
Hand Delivered
Date Scanned: 1 I Employee: Electronically Filed
Dale Data Entered: Employee: [3 Signer has not received
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 committee changes.
CRO -/000 NC State Board of Elections August 2008
Detailed Summary Amendment
sent
❑No
Use this form to summarize all disclosure reoortine forms and to total monetary information
1. Committee Full Name (and Fund if applicable)
2. Type of Report _
3. ID Number
C �a
Start of Election Cycle: January 1,oa 22
Total this
Reporting Period
Total this
Election Cycle
4) Cash on Hand at Start
$ / / 9 9 y rj
$ U, uru
RECEIPTS
5) Aggregated Contributions from Individuals (CRO -1205)
6) Contributions from Individuals (CRO -1210)
7) Contributions from Political Party Committees (CRO -1220)
$ / y0 W
$ / ([ C) 00
$ 6 5-3
$
$
$
8) Contributions from Other Political Committees (CRO -1230)
$
$ 570 U, oo
$
$
.00
$
9) Loan Proceeds (CRO -1410)
10) Refunds/Reimbursements to the Committee (CRO -1240)
11) Other Receipt Sources
Ila) Interest on Bank Accounts (CRO -1250)
$ C), v 5`$
U . 3 7-
11b) Contributions from Not -For -Profit Organizations (CRO -1250)
$
$
Ilc) Outside Sources of Income (CRO -1250)
l Id) Legal Expense Fund -Other Sources (CRO -1210)
l le) Exempt Purchase Price Sales (CRO -126s)
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines 5.6,7,8,9,10,11a,llb,llc.11dand Ile)
$/ 305.5 13
$3,2,9C/
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO -1310)$
13b) Contributions to Candidates/Political Committees (CRO -1310)
13c) Coordinated Party Expenditures (CRO.1310)
/ LS�sz 6D
$
$
$
$
$
14) Aggregated Non -Media Expenditures (CRO -1315)
$ l OU
$ v c}
15) Loan Repayments (CRO -1420)
$
$
16) Refunds/Reimbursements from the Committee (CRO -1320)
$
$
17) In -Kind Contributions (CRO -1510)
$ E S "3
$�
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15.16 and 17)
$ / z6 . /3
$
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$ q Y
$
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees (CRO -1330) $
1) Outstanding Loans (incl. ones from other campaigns) (CRO -1430)
2) Debts and Obligations owed by the Committee (CRO -1610)
$
$ "
$
$
3) Debts and Obligations owed to the Committee (CRO -1620)
Account Transfers Within the Committee (CRO -1720)
S) Administrative Support (CRO -1710)
$
$
6) Forgiven Loans (CRO -1440)
$
$
7) 48 -Hour Notice Reports Sum (CRO -2220)
$
$
8) Contributions to he Refunded (CRO -1215)
$
$
CRO -1100 NC State Board of Elections August 2008
Amendment
Loan Proceeds Pg _ of Yes ❑ Na
Use this form to report proceeds from a loan and loan endorser's information
CiQ to,) PO,- i{U ap v
3. Leader raformation ❑ Add ❑ Remove
a. Full Name, Nailing Address & Phone b. Job Title/Profession d. Continents
(Include city, stale, & zip)
C/C, VA)LeQ JoNe� - A ff�� Y
e. Start Dale (mmlddlyyyy)
5zz
�?v,Qc. Employer's Name(Specific Field �a/)Y/26Z
�� S
f. End Date (mm/dd/yyyy)
g. Rate h. Security Pledged t. Account Cale . Form of Payment k Amount
I. Full Name of Lending Institution Im. Loan Number
4. Endorser"i akers (The pcople mhn guaraurrc the loan.)
Ia. Full Name, Nailing Address & Phone b. Job Title/Profession C. Employer's Name/Specific Field
(include city, state, & zip)
(include city, state, & zip)
Percentage e. Amount
%n 1 $
.Anumot
rr S
Field
I5. Total of ALL CRO -1410 Pages 1 $ 5-,) C) , od I
(This line marl be on line 9 of Detailed Summary Page CRD•1100)
/W11J1110 NC&w, Rna,d of Flertinnc An61 2007
Amendment
Disbursements Pg _ of Yes ❑ No
Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political
committees and coordinated Darty expenditures
1. Committee Full Name (and Fund if app licable) _
C /4 4 f) ti ., n - 1�2� �1r f d
2. ID Number
fiU�1 L� P
ix. Type o Disbursement (Please use separate CRO -1310 forms for each type of DisbursernenrJ
® Oper:ain� Lvrcn_,c, ❑ C'nuihwunn to C',nJ ideie,B ilitwal C...niniucee ❑ Coordm et'd Pang Ls endiuties
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state,&zip). _ _
B/OSSOd-N 'f' l Ave ' '!�7
Oe Or.
6717 Ci/V (r C
C 7 ti 10 �e V C . 2 R Z Z 6
h. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
Federal U County:
El State ® Municipality:
e. Election Sum to Date
$/ Ls -5- ,60
. Account Cade
ar
g. Form of Payment
�e
h. Purpose Code
t. Date (mmlddlyyyy)
j. Amount
It. Required Remarks
.v og zazs$8FV,
5-
3 Coe Shc-e 13olkWe!
0 Z
/v i3 1.o z5"
$360,69
LCo Lie /3 //-/Vil
4. Payee Information ❑ Add El Remove
. Full Name, Mailing Addre„ F Himn,
(include city, state, & zip)
b. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
Q Federal ❑ County:
❑ State ❑ Municipality:
e. Election Sumte Date
$
J'. Amount Code
g. Form of Payment
It. Purpose Code
[i.Date (mm/dd/yyyy)
j. Amount
$
k Required Remarks
4. Payee Information Add Remove
a. Full Namur. Mailing Address & Phone
l include city, state, & zip)
b. Coordinated Committee Name
d. Continents
c. Level Registered (Specify)
Federal ❑ County:
❑ State ❑ Municipality:
e. Election Sam to Date
f. Account Code
g. Form of Payment
111a. Purpose Code
it. Date (mm/dd/yyyy)
1j. Amount
k. Required Remarks
$
S
5. Total only this Page
$ ZS i 6
6. Total of ALL CRO -1310 Pages
(Tins line goer in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses)
(This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm)
(This lime goes to line lar of Detailed Summary Page CRO -1100 i Cnnrdinaled Party r-rpendilnrrel
$
l/ ZSS
7. Purpose Codes (List detailed expenditure code in (h.) above)
.A* - Media B* - Printing C* - Fundraising D - To Another Gmdk atz
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 W
CRO -1.)10 NC State Board of Elections December 1009
VOTE.NOPTH CAROLINA
mT� STATE BOARD OF ELECTIONS
Loan Proceeds Statement
This Statement is used to report detailed information about a new loan and is required to accompany the
Loan Proceeds Form in the report for which the loan is initially disclosed. If the loan is from an individual,
the lender's signature is required on this form.
This Statement is to be filed with the Election Board where the committee's reports are filed.
�
• Name of committee to receive loan: rjavi'VA) to,- ajelcl%n/� 10--)
• Person or committee to make loan: _1cw1o�l ZPQToAe—S
• Date of loan to committee:
• Name of lending institution and account number (source):
• Amount of loan:
• Description (if in-kind loan):
• Names.1of all parties responsible for payment of loan (guarantors):
• Period of loan:
• Rate of interest of loan: O cz
• Security pledged for loan: N�4
l
Z-ee S , acknowledge that all of the information
Person lending money to committee)
provided is complete, true, and accurate. I further understand I may not forgive a loan
that ha an outstandin7bal,,nce to any source.
LQ
Sign a of Lender Date Signed
l� /U/ZG 25
Signattfre of Treasurer of Committee Date Signed
CRO-6/00 /_oan Pruceeds Stuiement