Anthony,Surluta_2026-Third Qtr Amendment 1_10-28-26Disclosure Report Cover ®evedme% No
Use this form for general report and conmdttee information, must be signed and submitted along with other detailed fomes.
Do not use this formic iodate information.
1. Committee Information
a. Full Name -
c. ID Number
COMMITTEE TO ELECT SURLUTA B ANTHONY
b. Mailing Address (include City, State and Zip Code)
it. Date Fled
1307VIRGINIA AVE
10/28/2026
MONROE, NC 28112
c. Phone Number
2. Report Year
13. Period Start Date (mm/dd/yy)
14. Period Find Date (mm/dd/yy)
5. Treasurer Full Name
2026
07/01/2026
10/17/2026
KATHLEEN M DOMANSKI
6. Type of Committee (Check One)
9. Type of Report (check only one type ofre ortfirom one calego )
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ Joint Fundraiser ❑ PAC
❑ Organizational
❑ Organizational
❑ Organizational
❑ Referendum ❑ Legal Expense Fwd
❑ Thirty-five day
❑ Pre-primary
® Pre-election
Quarterly
❑ First
❑ Second
❑ Pre -referendum
❑ Final
❑ Supplemental Final
7. Type of Fund (if applicable, check one)
❑ "Booster Fwd'
❑ BuildingFwd
❑ Pre -runoff
❑ Thad
❑ Annual
❑ Presidential Election Year Candidates Fwd
Semi-annual
❑ Fourth
❑ Special
❑ NC Public Campaign Financing Fwd
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
10. Special Report
❑ Other:
❑ Final
❑ Special
❑ Year End
❑ Final
❑ Special
S. Number of Fundraisers this Re rt
2
3. Account Information
3. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name _
FIFTH THM BANK
COUNTY
b. Purpose
c. Account Code
b. P GN FINA -
c. Account Code
FUNDRAISING AND
D2026
2026
SPENDING
GCT 3 0
d. Period Begin Balance
(. Period Begin Balance
$ i �� g�
RECEIVED
$
CFRTMCATION
I certify that the Committee orFund is in compliance with all applicable provisions of Article 22A, 22B & 2213-22M of
Chapter 163 of the NC General Statutes and that no funds are commingled with prohibited or other non-disclos ed
fund_s_.p I further^certify that this report is complete, true and correct and that I havebeen trained by the NC State Board
�2TYt wi®h n / `* d) � PR �� - SiY,� 10/28/2026 .
Printed Name of Signer Signature of Appointed Trea8.mer Date
FOROFFICEISEONLY I 2 1 ethod
rO rc
L'
Date Received: Employee:
[3 Normal Mail
'❑ Registered. Mail
Date Postmarked: Employee:
❑ 1Land Delivered
® Electronically Filed
Date Scanned: Employee:
❑ Signer has not received
Date Data Entered: Employee:
mandatory training ,_
Please Note: This fort cannot be used to amend committee information such as the committee address, treasurer,
assistant treasurer, custodian of books information, or account infomration.
You must amend the Statement of Organization CRO -2100A- to make committee changes. .
r Amendment
Detailed Summary IN Yes ❑ No
Use this form to summarize all disclosure reoortine forts and to total monetary inforrmtion
1. Committee Full Name and Fund if applicable
2. T of Report
13. ID Number
COMMITTEE TO ELECT SURLUTA B ANTHONY
2026 Pre -Election
Start of Election Cycle: January 1, 2025
Total this
Reporting Period
Total this
Election Cycle
4) Cash on Hand at Start
$
1,584.86
$
1,584.86
RECEIPTS
5) Aggregated Contributions fromindhiduals
(CRO -1205)
$
0.00
$
0.00
6) Contributions fromindi-0duals
(CR0-1110)
$
14,730.00
$
29,460.00
7) Contributions from Political Party Committees
(0?0-1210)
$
250.00
$
500.00
8) Contributions from Other Political Committees
(CRO -1230)
$
5,500.00
$
11,000.00
9) Loan Proceeds
(CRO -1410)
$
0.00
$
0.00
0) Refunds/Reimbursements to the Committee
(CRO -1140)
$
0.00
$
0.00
1) Other Receipt Sources
--
11 a) Interest on Bank Accounts
(CRO -1250)
$
0.00
$
0.00
11 b) Contributions from Not -For -Profit Organizations
(CRO -1250)
$
0.00
$
0.00
11 c) Outs ideSon rces of Income
(CRO -1150)
$
0.00
$
0.00
11 d) Legal ExpenseFund -Other Sources
(CRO -1270)
$
0.00
$
0.00
Ile) Exempt Purchase Price Sales
(CRO -1265)
$
0.00
$
0.00
2) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9,10,1la,llb, I lc l Id and Ile)
$
20,480.00
$
40,960.00
EXPENDITURES
3) Disbursements
13a) Operating Expenditures
(CRO -1310)
$
14,211.62
$
28,403.24
13b) Contributions to Candidates/Poli ti O� NG CR0-1310)
13c) Coordinated Partylripeod[tureCs�A �PA�IGN P (CIZ0-1310)
4) Aggregated Non -Media Expenditures 3 0 226 (0R0-1315)
5) Loan Repayments �� (CRO -1410)
$
$
$
$
$
2,000.00
0.00
0.00
0.00
50.02
$
$
$
$
$
4,000.00
0.00
0.00
0.00
100.04
C�lV
6) Refunds/Reimbursements from the Co mittee (CRO -1320)
7) In-IKndContributions
(CRO -1510)
$
3,500.00
$
7,000.00
8) TOTALEXPENDHURFS (Add lines 13a, 13b, 1% 14, 15, 16 and 17)
$
19 761.64
$
39,503.28
9) Cash on Hand at End (Add lines 4 and 12 toWhey then subtract line 18)
$
2,303.22
$
3,041.58
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees
(0?0-1330)
$
0.00
1) Outstanding Loans (incl. ones from other campaigns)
(0R0-1430)
$
0.00
-
2) Debts and Obligations ovvedbythe Committee
(CRO -1610)
$
0.00
3) Debts and Obligations roved to the Committee
(CR0-1620)
$
0.00
-
4) Account Transfers Within the Committee
(CRO -1720)
$
0.00
5) Adminis trative Support
(0?0-1710)
$
0.00
$
0.00
6) Forgiven Loans
(0?0-1440)
$
0.00
$
0.00
7) 48 -Hour Notice Reports Sum
(CRO -2220)
$
0.00
$
0.00
8) Contributions to be Refunded
([:RO-1215)
$
293.02
$
293.02
CR&1100 NC State Board of Elections Aupst 2008