smith,brandi_2025-YEAmendment
❑
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
. Full Name_ _ __ - _
__ _
I W 1
c. ID Number
b. Mailing Address (Include City, Slate and Zip Code) _
7 I &'� �� 0 •
it. Date Filed
j a 1-I QS
/\/C20-73
e. Phone Numb
—
qw
2. Repont Yeea�r
_X,)
3. Period Start Start ateV mm/dd/
�Ii
4. Period End Date (mmiddity5.
i a 3 i as
Treasurer Full e
6. Type of Committee (Check One)
andidate Campaign ❑ Pany
PAC ❑ Referendum
❑ Independent Expenditure ❑ Joint Fundraiser
❑ Legal Expense Fund
9. Type of Report (check
Municipal
❑ Organizational
❑ Thirty-five day
Pre-primary
only one type of reporf
Smle/ unty
rganiutional
Quarterly
❑ First
from one category)
Referendum
❑ Organizational
❑ Pre -referendum
❑ Final
Pre-election
Pre -runoff
Semi-annual
❑ Mid Year
❑ Second
❑ Third
❑ Founh
Semi-annual
❑ Supplemental Final
❑ Annual
❑ Special
7. Type of Fund (if applicable, check one)
❑ Booster Fund
E] Building Fund
❑ Oiher
Year End
❑ Final
r]Special
❑ Mid Year
Year End
[3Final
10. Special Report Name
8. Number of Fundrai ers this Report
❑ Special
11. Account Information
11. Account Information
. Financial Institution Full Name
a. Financial Institution Full Name
r n
1"0l J W V
b. Purpose J
c. Account Code
b. Purpose' f.;N i -
c. Account Code
Ga"a)Sn-,)N
�5
JAN 28 lino
it. Period Begin Balance
d. Period Begin Balance
s
RECEIVED
CERTIFICATION
I certify that the Committee or Fund is in compliance with all applicable provisions of - le 22A. 22B & 2213-22M of Chapter 163
of the NC General Statutes and that no funds are commingled with prohibited or other non-dis to d funds. I further certify that this
repo)7complete, true and correct d that I have been trained by the a State Board of Elections.
�y
Printed Name of Signer Si nat e OINAppctihliad Treasurer Date
FOR OFFICE USE ONLY
hh ivery Method
Date Received: d Employee: 67;n�l
Normal Mail
Date Postmarked: Employee: Registered Mail
Hand Delivered
Date Scanned: Employee: Electronically Filed
Date Data Entered:Employee: C3Signer has not received
mandatory 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 -2 I OOA-E) to make committee changes.
CRO-iU00 NC State Board of Elections August 2008
Detailed Summary Amend
1s nt No
Use this form to summarize all disclosure- re.nnttinn forms and to total monerary infnrmnrinn
1. Committee Full Name (and Fund if applicable)
2. Type of ReportI N her
Start of Election Cycle: Ianuarc 1,
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)
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
Ila) Interest on Bank Accounts (CRO -1250)
I lb) Contributions from Not -For -Profit Organizations (CRO -1250)
11C) Outside Sources of Income (CRO -1250)
lid) Legal Expense Fund - Other Sources (CRO -1270)
Ile) Exempt Purchase Price Sales (CRO.1265)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines 5,6,7,8,9,10,1la,lib,lle,lldand Ile)
$0.00
$
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)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, I6 and 17)
$0.00
$
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18.
SJD-.W ` t30
$
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees (CRO -1330)
21) 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)
4) Account Transfers Within the Committee (CRO -1720,
5) Administrative Support (CRO -1710)
6) Forgiven Loans (CRO -1440)
27) 48 -Hour Notice Reports Sum (CRO -2220)
28) Contributions to be Refunded (cxo-Izls)
$
$
S
S
$
S
'S
$
$
$
$
$
t RD•II00 NC State Board of Elections August 2008
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