Anthony_Surluta_2026-Third Qtr Amendment 2_10-29-26Amendment
Disclosure Report Cover ®Yes ❑ No
Use this form for general report and corrnmttee inforrrtation, nmst be signed and submitted along with other detailed forret.
n.. ...., ....e fh;: C.,,, r..,.n Jl tr mfmm�tinn
1. Committee Information
a.. Full Name -
-
c. ID Number `
COMMITTEE TO ELECT SURLUTA B ANTHONY
b. Mailing Address, (include City, State and Zip Code)
d. Date Fled
1307VIRGINIA AVE
10/29/2026
MONROE, NC 28112
e. Phone Number
2. Report Year
13. Period Start Date (mm/ddyy)
14. Period Find Date (mm/dd/-y)
15. Treasurer Fuil 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 ofrep ortfrom one category)
® Candidate Campaign ❑ Party
Municipal -.
State/County-
Referendum
❑
Organizational
❑ Organizational
❑ Organizational
❑ Joint Fundraiser ❑ PAC
❑ Referendum ❑ Legal Expense Fund
❑
❑
®
Thirty-five day
Pre-primary
Pre-election
Quarterly
❑ - First
❑ Second
❑ Pre-referendimm
❑ Final
❑ Supplemental Final
7. Tvm of Fund (iii -applicable, check one)
❑ "Booster Fund'
❑ Building Fund
❑
Pre-nmoff
❑ Third
❑ Annual
❑ Presidential Election Year Candidates Fund
Semi-annual
❑ Fourth
❑ Special
❑ NC Public Campaign Financing Fund
❑
Mid Year
Semi-annual
10. Special Report Name
❑
Year End
❑ Mid Year
❑ Other:
❑
❑
Final
Special
❑ Year End
❑ Final
❑ Special
8. Number of Fundraisers this Re rt
2
3. Account Information
3. Account Information
a. Financial Institution Full Name _
a. Nnancial Institution Full Name
FIFTH THIRD BANK
b. Purpose
c.Account Code
b. Pu COUNTY
c. Account Code
FUNDRAISING AND
D2026
CAMPAIGN FINA
SPENDING
qq�r
n`'� 3 Q 2�LU
d. Period Begin Balance
di Period 'Begin Balanee
s 1
s
RECEIVED
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 conunurgled with prohibited or other non -disclosed
funds. I further certify that this report is complete, true and correct and that I have be n trained by the NC State Board
/w
10/29/2026
Pi Printed Nameo Signer
Signature of Appointed Treasurer Date
FOR OFFICE I SEONLY
!`
Delivery Method
Employee:
Date Received:
- ❑ NomnlMad
E3RegisteredMail
Date Postmarked:
to ee:
Fmp Y _ -❑ Hand Delivered
® Electronically Filed
Date Scanned:
FmPYto ee:
❑ Signer has not received
Date Data Entered:
_
Employee: .. [mandatory training
Please Note: This form cannot be used to amend cotrm itt_ee information such as the committee address, treasurer,
assistant treasurer, custodian of books information, or account information.
You must amend the Statement of Organization
CRO -2100A- to make conanittee changes.
Amendment
Detailed Summary ® Yes ❑ No
ll di closure re orcin forms and to total moneta information
Use thrs form to sunum a sr ii
1. Committee Full Name and Flood ifapplicable) - -
2. Type of Report
.3.ID.Number
CONMUTTEE TO ELECT SURLUTA B ANTHONY
2026 Pre -Election
Start of Election Cycle: January 1, 2025
Reporting
Total this
Period
Total this
Flection Cycle
4) Cash on Hand at Start
$
1,584.86
$
1,584.86
RECEIP-fS, ',
5) Aggregated Contributions fromindividuals
(CRO -1205)
$
0.00
$
0.00
6) Contributions from Individuals
(CR04210)
$
14,730.00
$
29,460.00
7) Contributions from Political Party Committees
(CRO -1220)
$
250.00
$
500.00
8) Contributions from Other Political Committees
(CRO -1130)
$
5,500.00
$
11,000.00
9) Loan Proceeds
(CRO -1410)
$
0.00
$
0.00
0) Refunds/Reimbursements to the Committee
(CR04240)
$
0.00
$
0.00
1) Other Receipt Sources
I la) Interest on Bank Accounts
(CRO -1250)
$
0.00
$
0.00
11b) Contributions from Not-For-ProfitOrganizations
(CRO -1250)
$
0.00
S
0.00
Ile) Outside Sources of Income
(CR0.1250)
$
0.00
$
0.00
I1d)LegalExpenseFund-Other Sources
(CRO -1270)
$
0.00
$
0.00
11 e) Exempt Purchase Price Sales
(CR61=7265)
$
0.00
$
0.00
2) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10,1 la, Ilb, Ilc,l ld 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/Political Committees (CRO -1310)
V
13c) Coordinated Party Expenditures ION CO VSCR0.1310)
�IC
4) Aggregated Non -Media ExpendituawpoC'NFI'A (CRO -1315)
$
$
$
2,000.00
0.00
0.00
$
$
$
4,000.00
0.00
0.00
5) Loan Repayments nrY 1 (I TO
(CRO -1420)
$
0.00
$
0.00
6) Refunds/Reimbursements from the Committee
(CRO -1320)
$
50.02
$
100.04
7) In-KtndContributions
(CR0.1510)
$
3,500.00
$
7,000.00
8) TOTALEXPENDrfURFS (Add lines 13a,13b, 13c, 14, 15, 16 and 17)
$
19 761.64
$
39,503.28
9) Cas h on Hand at End (Add lines 4 and 12 together, then subtract line 18)
$
2,303.22
$
3,041.58
ADDTITONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees
(CRO -1330)
$
0.00
1) Outstanding Loans (incl. ones from other campaigns)
(CRO -1430)
$
0.00
2) Debts and Obligations mvedbythe CommitteleOVrljy C�cRO-1610)
$
0.00
N lq FlNAN (CRO -16 20)
3) Debts and Obligations owed to theC iXA r^1
4) Account Transfers Within the Co"tteAI 3 Q Z�`6 (CR0.I720)
5) Administrative Support G�`yED(CRO-1710)
$
$
$
0.00
0.00
0.00
$
0.00
6) Forgiven Loans RE
(CR9-1440)
$
0.00
7) 48 -Hour Notice Reports Sum
(CRO -2220)
$
0.00
8) Contributions to be Refunded
(CRO -1215)
$
293.02
$
293.02
.. Dona
CRO -1100 Nu mare uoae or Erect uns �•��•