Anthony,Surluta_2026-Third Qtr CoverDisclosure Report Cover Amendment
❑ Yea ® 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. to Number
COMMITTEE TO ELECT SURLUTA B ANTHONY
46-3149470
b. Mailing Address (include City, State and Zip Code)
d. Date Fled
1307 VIRGINIA AVE
MONROE
10/26/26
e. Phone Number
NC
28112
7046184116
2. Report Year
3. Period Start Date (mm/ddlyy)
4. Period End Date
(mm/dd/yy)
5. Treasurer Full Name
2026
07/1/2026
10/17/2026
KATHLEEN M DOMANSKI
6. Type of Committee Check One)
9. Type of Report check only
one type of report om one calegoty
® Candidate Campaign ❑ Party
Municipal
State/County -
Referendum
❑ PAC ❑ Referendum
❑
Organizational
❑ Organizational
❑ Organizational
Independent ❑ Joint Fundmiser
❑ Expenditure
❑
Thirty-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fond
❑
❑
Pm -primary
Pre-clection
'
❑ First
❑ Second
❑ Final
❑ Supplemental Final
7. Type of Fund Wapplicable,.checl. one)
❑ "Booster Fund"
❑ Building Fund
❑
Pre-mnoff
® 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
FIFTH THIRD BANK
RECEIVED
b. Purpose
c.Account Code
b. Purpose_
-c. Account Code
FUNDRAISING
D2026
OCT 2 6 2026
d. Period Begin Balance
UNION COUNTY
BOARD OF ELECTIONS
it. Period Begin Balance
$ 1584.86
$
CERTIFICATION
I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 2213, & 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 correctand th tt I have been trained
ia', OV1 o N CY t
by the N State Board o le ons.
Q12Gr
7
to
nted Name of Signer
Signature ofAppointed Treasurer
Date
FOR OFFICE USE ONLY
Date Received: /
Employee:
Delivery Method
❑ Normal Mail
Date Postmarked:
Employee:
Registered Mail
Hand Delivered
Date Scanned:
Employee:
Electronically Filed
❑ Signer has not received
Date Data Entered:
Employee:
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.
Vent most amend the Statement of Omanization (CRO -21 ODA -E) to make committee
chanees.
Detailed Summary Amen
Y smemEN No
Use this form to summarize all disclosure reporting fonts and to totalmonetary infomation
1. Committee Full Name and Fund ifapplicable)
2. Type,-fD-port
3.IDNumber
COMMITTEE TO ELECT SURLUTA B ANTHONY
j�iY,}
G Ul
Start of Election Cycle: January 1, 2025
Total this
Reportin Period
Total this
Rection Cycle
4) Cash on Hand at Start
$
1,584.86
$
1,584.86
RECEIPTS
5) Aggregated Contributions fromindividuals
(CRP -1205)
$
0.00
$
0.00
6) Contributions from Individuals
(CRO -1210)
$
14,730.00
$
14,730.00
7) Contributions from Political Party Committees
(CBO -1220)
$
250.00
$
250.00
8) Contributions from Other Political Committees
(CRO -1230)
$
5,500.00
$
5,500.00
9) Loan Proceeds
(CRO -1410)
$
0.00
$
0.00
0) Refunds/Reimbursements to the Committee 1
(0?0-1240)
$
0.00
$
0.00
1) Other. Receipt Sources
IIa) Interest on Bank Accounts
(CRO -1250)
$
0.00
$
0.00
11b) Contributions from Not -For -Profit Organizations
(CRO -1250)
$
0.00
$
0.00
I lc) Outside Sources of Income
(CR0.1250)
$
0.00
$
0.00
11d) Legal Expense Pund-Other Sources
(CRO -1270)
$
0.00
$
0.00
Ile) Exempt Purchase Price Sales
(CRO -1265)
$
0.00
$
0.00
2) TOTALRF:CEIPTS (Add lines 5, 6, 7, 8, 9,10,11a,I Ib,I Ic,lld and Ile)
$
20,480.00
$
20,480.00
EXPENDITURES
3) Disbursements
-
-
13a) Operating FKpenditures
(CR0.1310)
$
14,191.62
$
14,191.62
13b) Contributions to Candidates/Political Committees
(CBO -1310)
$
2,000.00
$
2,000.00
13c) Coordinated PartyEgxuditures
(CRO -1310)
$
0.00
$
0.00
4) Aggregated Non-MediiaExpenditures
(CRO -1315)
$
0.00
$
0.00
5) Loan Repayments
(CR04420)
$
0.00
$
0.00
6) Refunds/Reimbursements from the Committee
(CRO -1320)
$
50.02
$
50.02
7) In-l(indContributions
(CRO -1510)
$
3,500.00
$
3,500.00
8) TOTAL EXPENDHIJM (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$
19 741.64
$
1974164
9) Cas h on Hand at End (Add lines 4 and 12 togther, then subtract line 18)
$
2,323.22
$
2,323.22
ADDMONAL INFORMATION "
0) Non -Monetary Gifts Given to Other Committees
(CBO -1330)
$
0.00
1) Outstanding Loaus (incl. ones from other campaigns)
(CRO -1430)
$
0.00
2) Debts and Obligations ouedbythe Commi 0-1610)
GEIV_E�
3)Debts and Obligationsouedtothe..Commi ee �tj}(CR0.1620)
4) Account Transfers Within the Committee OCT 2 �L�6CHO-1720)
$
0.00
-
$ 0.00
$ 0.00
-
5)Administrative Support UNIONCO]t 00)
C
$
0.00
$
0.00
BOARD OPEC
6) Forgiven Loans
(CRO -1440)
$
0.00
$
0.00
7) 48 -Hour Notice Reports Sum
(CRO -2210)
$
0.00
$
0.00
8) Contributions to be Refunded
(CRO -1215) I
$
293.02 IS
293.02
CR(1-1100 NC State Board of Elections August 2008