2019_Organizational ReportAmendment
Disclosure Report Cover 13 Yea m No
Use this form for general report and committee information, trust be signed and submitted along pith other detailed Coma.
Do not use this fornto undate infnrmntion
1.
a. Full Name
c. ID Number
A BETTER MARSHVILLE FOR TOMORROW
b. Maiiiog Address (include City, State and Zip Code)
d. Date Filed
3103 JULIAN GLEN CR
W AXHAW, NC 28173
11/01/2019
e. Phone Number
18281776-2774
4. Pe r Fu11 N
2019 10/22/2019
10/31/2019 JINGER KFLLEY
6. Type of Committee (ChecM11111W
9. Type of Report (check
only one type ofrepd
mom o
❑ Candidate Campaign Party
Municipal
State/County
Referendum
❑ Joint Fundraiser 11 PAC
®
Orgw tional
Organizational
❑ Organizational
Q Referendmn r1l Legal Expense Fund
❑
Thirty-five day
Quarterly
Q Pre -referendum
J
❑
Pre-primary
❑ First
❑ Final
"Booster Food"
❑
Pre-election
❑ Second
❑ Supplemental Final
Q Building Food
❑
Pre-nmoff
Q Third
❑ Annul
Q Presidential Election Year Candidates Fund
Semi-annual
Q Fourth
❑ Special
❑ NC Public Campaign Financing Food
❑
Mid Yeur
Semi -annul
❑
Year End
[3 Mid Year
Q Other:
❑
Final
❑ Year End
❑
Special
❑ Final
0
❑ Special
3. Account Information
3. Account information 7
a. Financial Institution Full Name
a. Financial In stitutiun Full Name
FIRST CITIZENS BANK
L Purpose
c. Account Code
b.c.
Account Code
MAINTAIN RECORD OF
01
NEU
CONTRIBUTIONS &
EXPENSES
NOV 01 2019
d. Period Begin Balance
d. Period Begin Balance
0.00
S
CERTIFICATION
1 certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 22113-22M of
Chapter 163 ofthe 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
,
i n A.l.f K l,� (.8,,,
11/01/2019
inted Name of Signer
Sign eof AppointedTr surer Date
FOR OFFICE USE ONLY
Dale Received: il d ( q
Delivery Method
Empl
[3 Normal Mail
Date Postmarked:
Employee: [Z Registered Mail
Hand Delivered
Date Scanned:
Electronically Filed
Employee:
Date Data Entered:
Employee: ❑ Signer 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 inforrretion, or account information.
You must amend the Statement of Onzanization
CRO -2100A- to make committee changes.
CRO -1000 NC State Board of Elections December 2007
IAmeadmtat
Detailed Summary p Yts ® No
Use this form to summaria all disclosure rcoortinp. forms and to total monetary in fomotion
1. Committee FLIT Name amd Frond it icable) of Report 13. ID Number
A BETTER MARSHVILLE FOR TOMORROW 2019 Organizational
Start of Election Cycle: January 1, _010I(o Total this Torsithis
Re rtin Period Total
Cycle
4) Cash on Hand at Start I S 0.00 s n nn
RECEIPTS_
5) Aggregated Contributions fromlodhiduals
(CR0-1205)
$
0.00
$
0.00
6) Contributions from In l-Aduals
(CRO -1210)
$
1,800.00
$
1,800.00
7) Contributions from Political Party Committees
(CRO -1210)
$
0.00
$
0.00
8) Contributions from Other Political Committees
(CRO -1230)
$
0.00
$
0.00
9) Loan Proceeds
(CRO -1410)
$
0.00
$
0.00
0) Refunds/Reimbursements to the Committee
(CRO.1240)
$
0.00
$
0.00
1) Other Receipt Sources
Ola) Interest on Bank Accounts
(CRO.1250)
$
0.00
$
0.00
11 b) Contributions from Not -For -Profit Organizations
(CRO -1250)
$
0.00
$
0.00
Ile) Outside Sources of Income
(CRO -1250)
$
2,500.00
$
2,500.00
Old) Legal Eri ease Fund- Other Sources
(CRO -1270)
$
0.00
$
0.00
Ile) FlemptPurchase Price Sales
(010-1165)
$
0.00
$
0.00
2) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10,11 a, 11b,I Ic,I Id and l le)
$
4,300.00
$
4,300.00
EXPENDITURES _
3) Disbursements
139) Operating Expenditures
(CRO -1310)
$
177.40
$
177.40
13b) Contributions to Candidates/Political Committees
(CRO -1310)
$
0.00
$
0.00
13c) Coordinated Party Fhpenditures
(CRO -1310)
$
0.00
$
0.00
4)Aggregated Non -Meda lkpenditures
(CRO -1315)
$
0.00
$
0.00
S) Ivan Repayments
KNO-1420)
$
0.00
S
0.00
6) Refunds/Reimbursements from the Committee
(CRO -1320)
$
0.00
$
0.00
7) hs -Wind Contributions
(CRO -1510)
$
0.00
$
0.00
8) TOTAL EXPENDI7114M (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$
177.40
$
177.40
9) Cas b on Hand at End (Add lines 4 and 12 together, then subtract line 18)
$
4,122.60
$
4,122.60
DITIONAL INFORMATION
Non -Monetary Gifts Given to Other Committees
(CRO -1330)
$
Outstanding Loam line[. ones from other campaigns)
(CRO -1430)
$
Debts and Obligations owed by the Committee
Debts and Obligations owed to the Committee
Account Tramsters- flC4',G V F D
(CRO -1610)
(CRO -1620)
(CRO -1710)
$
$
$
Administradwe Support
(CRO -1710)
$
Forgiwu Loans
(CRO -1440)
$
48 -Hoar Notice Reports6f" Co. Board ons(CRO-2220)
$
Contributions to be Refunded
(CRO -1215)
$
0.00
0.00
0.00
0.00
0.00
0.00
$
0.00
0.00
$
0.00
0.00
$
0.00
0.00
$
0.00
Contributions from Individuals Pg I of 2 p YC mens No
Use this form to report individual contributions over $50 or contributions under $50 if lbrin CRO 1205 is not used
ONSUMdUee FWI Name(and Flmdif
A BETTER NIARSI MLLE FOR TOMORROW
3. Contributor Information
a. Full --Name, Mailing Address & Phone b.Job 7itle/Professioa
(include city, state, & zi p) CATERING
KATHERYN E DAVIS
511 BIVENS ST a Hoployer's Name/Specific Field
WINGATE, NC 28174 SELF
&Comments
e. Election Sum to Date
$ 300.00
L Prior
g. Account Code
It. Form of Payment
i. In-IGnd Description
j. Date (mm/dd/yyyy)
it. Amount
❑
01
Check
10/22/2019
$ 300.00
❑
$
3. Contributor Information 40L. ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Jitlefl'rofession
it. Comments
OWNIi R
ANTHONY HELMS
1142 HIGHWAY 205 N
MARSHVILLE, NC 28103
a Employer's Name/Specific Held
HELM'S METALS
e. Deetion Som to Date
$ 300.00
f. Prior
❑
g. account Code
It. Form of Payment
i. to-IGnd Description
J. Date (mm/dd(yyyy)
it. Amount
Check
10/31/2019
$ 300.00
❑
3. Contributor Information
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
A Job'Dtle/Profession
$
& Comments
PRESIDENT
MATTHEW MILLS
723 OLD WHY 74
MARSHVILLE, NC 28103
c. Employer's Name/Specific Field
PEP INC
e. Fieetioa Sam to Date
$ 300.00
L Prior
O
S. Account Code
01--
It. Form of Payment
_ - Check
i. In -Ki nd llescription j. Date(mm/dd/yyyy)
10/31/2019
Is. Amount
$ 300.00
E3
$
❑ S
4. Total only this PA 900.00
5. Total of ALL CR 1,800.00
(This fine must wazikyEaq Page CRO -110 .
CRQI210 NC State Board of Elections April2007
NOV 01 2019
Union Co. Board of Elections
Contributions from Individuals Amendment
Pg of ' ❑ \es ®No
Use this form to report indis-idual contributions over S50 or contributions under S50 it lixm CRO 1215 is not used
A BETTER MARSHV ILLE FOR TOMORROW
3. Canlribdtar Information ❑ Add ❑ Remove
a. Full Name. %tailing Address & Phone
(include city, state,&zip) _..-
ROBERTPALMER
1809 DOCTOR BLAIR RD
MARSHVILLE, NC 28103
b. Job Tttle/Profession
d. Comments
ATTORNEY
c. Employer's Name/Speeifie Field
ROBERT PALMER PLLC
e. Election Som to Date
S 300.00
f. Prior
g. Account Code
b. Form of Payment
i. In-10nd Description
J. Date (mm/dd/yyyy)
Is. Amount
❑
01
Check
10/31/2019
$ 300.00
❑
S
❑
g
3. Contributor Information ❑ Add ❑ Remove -
a. Full Name, ,flailing Address & Phone
(include city, state, & zip) _
KERRY K PIERCE
2015 CAMDEN RD
WINGATE, NC 28174
b. Job Title/Profession
d.
Comments
VICE PRES
c. Employer's Name/Specific Field
FIRST CITIZENS BANK
e. Election Sum to Date
$ 300.00
f. Prior
g. Account Code
h. Form of Payment
i. to -Kind Description
j. Date (mm/ddlyyyy)
Is. Amount
❑
01
Check
10/22/2019
$ 300.00
❑
q
❑
S
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, )Sailing Address & Phone
(inclade city, state, & zip)
b. Job'litle/Profession
PRESIDENT
d. It
._.
CHAD WHITLEY
16524 AUSTIN RD
LOCUST, NC 28097 Nov 0 2019
c. tmploter's Name/Specific Feld
---
WHITLEY INVESTMENTS
e. Election Sam to Date
S 300.00
f. Prior
❑
g. Account Code
of
b. Form of Payment
Check
i. In -land Description
I. Date (mm/dd/yyyy)
k. Amount
10/31/2019
$ 300.00
❑ $
4. Total only this Page $ 900.00
5. Total of ALL CRO -1210 Pages $ 1,800.00
(This line must bean fine 6 ojDemiled Summary Page CRO -11
CRU -1210 NC State Board of Elections April 2007
Other Receipt Sources pg I of 3 Amendment
0 Yea ® No
Use this form to report income not reported on :mother lotrn. i.e. interest income, not for profit contributions etc.
A BETTER MARSHVILLE FOR TOMORROW
3. Type of , _ r
❑ Interest Lj Contributions om Not-or-Profit Organvalions 0 Outside Sconces of Income
4. Contributor information - - Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Not-for-Profit Federal to #
d. Comments
BYRUM HEATING & A/C INC
PO BOX 160
MARSHVILLE, NC 28103
c. Outside Source Explanation
e. Election Sum to Date
$ 500.00
L Aeeoot Code
g. Form of Payment
1h. In-load Description
I. Date (mm/dd/yyyy)
j. Amount
01
Check
10/22/2019
$ 500.00
$
4. Contributor Information ❑ Add ❑ Remove -
'
a. Full Name, Mailing address & Phone
(include eity,state. & iipt
GAYECHEVEROLE"I-INC
PO BOX 645
MARSHVILLE, NC 28103
h. Not-fur-Profit Federal to
d. Comments
c. Outside Source Uplanation
e. Election Sum to Date
$ 300.00
L Account Code
g. Form of Payment
Check
h. In-Kind Description
I. Date(mm/dd/yyyy)
J. Amount
of
10/22/2019
$ 300.00
-.Contributor Information
❑ \dd ❑ Renv%c
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Not-for-Profit Federal to #
d. Comments
H&S PAVING LLC
PO BOX 766 ECE�VEp
MARSHVILLE, NC 2811
NOV � i 2U19
c. Outside Source Explanation
e. Election Som to Date
$ 300.00
L Account Code
Il. Formet Paym �t ptiou
1. Date (mm/ddlyyyy)
j. Amoant
01
Ch
10/31/2019
$ 300.00
$
5, Total only this Page g 1,100.00
6. Total of ALL CRO-1250 Pages
(This line goes in tine Ila of Derailed Summary Page CRO-1100 iflnteres0 $ 2,500.00
!This line goes in line Iib of Dem Jed Summary Page CRO-1100 ifNot forvProfu (onrribudon)
(This fine goes in line Ile ajD10emiledSummary Page C1iff Osm&e Soarca o !_neo
CRO-1250 NC State Board of Elections December 2007
Amendment
Other Receipt Sources pg 2 of 3 ❑ Nes ® No
Use this form to report income not reported on another form i.e. interest income, not for pro lit con Irihtit ions etc.
A BETTER MARSHVILLE FOR TOMORROW
Interest Contributions from Not -for -Profit Organizations Outside Sources of Income
4. Contributor Inforttadm
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
Id 1i6d'164'�
It. Not -for -Profit Federal to g
d. Comments
HALL'S AUCTION LLC
217N ELM ST
MARSHVILLE, NC 28103
c. Outside Source Explanation
e. flection Sam to Date
$ 300.00
f. Account Code
g. Form of Perm a nt
1h.In-IGod Description
I. Date(mm/dd/yyyy)
j. Amount
01
Check
10/31/2019
$ 300.00
. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing :Address & Phone
(include city, state. & lip)
LANDPEDDLARS FLP
PO BOX 723
MARSHVILLE, NC 28103
h. Nut -for -Profit Federal ID #
_.-------
d. ('omments
---
c. Outside Source Explanation
e. Election Sam to Date
$ 300.00
f. lccou nI( -tide
°i
g. Donn of Pa) in e n t
,ccs
h. In -Kind Description
I. Date (mm/d&My)j.
Amount
10/22/2019
$ 300.00
4. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Not -for -Profit Federal too
d. Comments
MARSHVILLE ROCK STORE BBQ
6608 E MARSHVILLE RD ECEN Ep
MARSHVILLE,NC 281038
C. Outside Source Explanation
e. t]eetioe Sam to Date
$ 150.00
Atmamt Cmk
g.Formof Payment
'tion 11.
Date(mm/dd/yyyy)
10/31/2019
J. Amount
$ 150.00
01
Chec
5. Total only this Page $ 750.00
6. Total of ALL CRO -1250 Pages
(This fine goes in line Ila of Derailed Summary Page CRD -1100 #'Interest) $ 2,500.00
(This line goes in Rne Alb ofDemOed Summary Page CRO -1100 IfNot for-Proftr Contribution)
IT" &e goes in fine Ile ofDemfied Summary Page CRO -1100 jf 0wa ide Sources of Income) 1
CRO -1250 NC -Sate Board of Elections December 2007
Amendment
Other Receipt Sources Pg 3 of - ❑ ties ® No
Use this form to report income not reported on another form i.e. interest income, not for profit contrihut ions etc.
N4
A BETTER MARSHVILLE FOR TOMORROW
Interest Contributions from N'nt-for-Profit Organizations Outside Sources of Income
4. Contributor Information ❑ Add Remove
e. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Not -for -Profit Federal [DO
d. Comments
PIEDMONT FLOORING LLC
214 W MAIN ST
MARSHVILLE, NC 28103
c. Outside Source Explanation
e. Election Sum to Date
$ 500.00
f.Account Code
g. Form of Payment
1h. In -fund Description
1. Date (mm/dd/yyyy)
J. Amount
01
Check
10/22/2019
$
500.00
4. Contributor laformation ❑ Add ❑ Remove
_
a. Full Name, Mailing Address & Phnne
(include cit), state, & zip)
STEGAL SMOKED TURKEY INC
6608 E MARSHVILLE RD
MARSHVILLE, NC 28103
b. Not -Tor -Profit Federal ID#
d. Comments
r. Outside Source Explanation
e. Election Sam to Date
$
150.00
E Accou nt(ode
g. Form of Pay ment
—Check
h. In -turd DeseAption i. Data(mm/dd/yyyy)
10/31/2019
j. Amount
$
150.00
5, Total only this Page
$
650.00
6. Total of ALL CRO -1250 Pages
(This One goes in One Ila of Detailed Summary Page CRO -1100 if Interest)
(This linegoes in line 1 /b of Derailed Summary Page CR0./ /00 if Nat forvProfit Contribution)/This line goes in line Ile ofDetaded Summary Page CRO.1100 Ounide Soarces of Income)
$
2,500.00
t H0-1-'10 NL state Board of Elections December 2007
RECCNED
Nov 01 2019
Union Co. Board d Electlons
Ameadment
Disbursements Pe i of I ❑ Yes ® No
Use this formic, report expenditures from the committee lbroperating cspcnses, contributions to candidate/political
committees and coordinated party expenditures
A BE I IFR MARSHVII_LE FOR TOMORROW
3. Type of Disbursemente R
Operumel. \pcnsca U ContnMnionSto Candidates/political Committees U Coordinated Party Expenditures
4. Payee htformation
❑mo,❑ Retmve
a. Full Name, Mailing Address & Phone
include city, state,&zi
b. Coordinated Committee Name
d. Comments
CHECKS FOR LESS
200 RIVERSIDE INDUSTRIAL PKWY
PORTLAND, ME 04103
c. Level Registered (Specify)
L3Federal County:
❑ State ❑ Municipality:
e. Heetiou Sam to Date
$ 52.40
L Account Code g. Form of Payment 111a. Purpose Code
If. Date (mm/dd/yyyy) j. Amount k. Required Remarks
10/28/2019 $ 52.40 ICIIECKSfDEPOSITBKS
01 Debit Card K
4. Payee %lbrmadan
S
7177dd ❑ Remove
a. F ull Narne,Mailing Address&Phone
include city, state & zip)
b.Coordinated Commiuee.Name
d.Comments
L2, INC
18912 NORTH CREEK PKWY
BOTHELL, WA 98011
c. Level Registered (Specify)
Federal L3 County:
❑ state ❑ Municipality:
e. Rection Sum to Date
$ 125.00
L Account Code
1g. Form Payment
1h. Purpose Code
i. Date (mm/dd/yyyy) 1j. Amount k. Required Remarks
01
_of
Check
O
10/23/2019 IS 125.00 CONTACT LISTS
.5. Total only this Page .... _:....
$
- _ � _... $ 177.40
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a ofDemiled Summary Page CRO -1100 if0perating Expenses) $ 177 40
(This line goes in One 13h ofDemiled Summary Page CRO -I 100 ifComrib m Candidateslpo4tieal Comm)
(Thin line goes in litre 13c nfDetailed Summary Page CRO -1100 if Coordinated Pony Expenditures)
7. Purpose Codes (List detailed expendhuro
A* - Media B* - Printing C* - Fundraising D -To Another Candidate
E - Salaries I* - Equipment G - Political Party H* - Holding Public Office Expenses
I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* Other
c ii&i3iu NC mate tsoara or tiecuons December 2009
RECEIVED
NOV 01 2019
Union co. Board of Elections