Alsobrooks, Clarence_2021-Pre-ElectionReportAmendment
Disclosure Report Cover ❑ Yea CN No
Use this form for general report and committee information, must be signed and submitted along with other deta ed forms.
Do not use this form to update information.
1. Committee Information
. Full Name
c. ID Number
Ct-^IKI 14ee Affeel 0hreacel /c e,
/-/-r#f til
. MaWog Address (include City, State sed 73p Code)
d. Date plied
po Blix 17g� P; hek)5 �c — -
(--, 20zi
e. Phd6e Niallier
_. Report Year
3. Period Start Date end 4. Period End Datemmf
5. Treasurer Full Name
2-I Z
2e Z I /211'z/gor
of Committee_(Ch One)
9. Type of Report check only one type of reportfrom one category)
Candidate Campaign ❑ Party
Municipal
Statetcounty
Referendum
❑ PAC ❑ Referendum
rganizational
❑ Organizational
Organizational
❑ Independent Expenditure ❑ Joint Fundraiser
- w day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑ First
❑ Final
^^
<lection C fl
❑ Second
❑ Third
❑ Supplemental Final
❑ Annual
7. Type of Fan_d (if applicable, check one)
❑ Booster Fund
Semi-annual
❑ Fourth
❑ Special
❑ Building Fund
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
10. Ppedal Report Name
❑ Other:
❑ Final
❑ Special
❑ Year End
❑ Final
8. Number_ of Fundraisers this Report
L9
❑ Special
11. Account Information
11. Account Information
. Financial Institution Full Name
a. Financial Institution Full Name
I.
1
b. Purpose
c. Account Code
016rPose
OCT 2 0 2021
c. Acci mt Code
4 s cxFeme1
Pe" Begin Balance
. Period Begin Balance
ryry
E C E I V E L/
O
CERTIFICATION
1 certify that the Committee or Fund 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 -disclosed funds. 1 further certify that this
report is complete, true and correct and that 1 have been trained by the NC State Board of Elections.
G T262!
( Ial )(e xlvl jwl, : Tf e,
Printed Name of Signer Si nature of Appointed Treasure to
FOR OFFICE USE ONLY
(t D
Dale Received: Employee:
E3elivery Method
Normal Mail
Afigg
Date Postmarked: Mail
ked: Employee:
Hand Delivered
Date Scanned: Employee: Electronically Filed
Date Data Entered: Employee: ❑ Signer has not remandatory train
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 -2100A -E) to make committee changes.
CRO -1000
NC State Board of Elections
August 2008
0
M
Detailed Summar Amendment
y ❑Yes ❑ No
Use this form to summarize all disclosure renortinn fnr ns and to total monetary infnrmation
1. Committee Full Name (and Fund if applicable)
2. Ty a of Re
rt
3. ID Number
iio4
7(e
e
101_
F
M L i
Start of Election Cycle: January 1, 20 ZD
Total this
Reporting Period
Total Cy
Election Cycle
4) Cash on Hand at Start
$
$
RECEIPTS
5) Aggregated Contributions from Individuals
6) Contributions from Individuals
7) Contributions from Political Party Committees
8) Contributions from Other Political Committees
9) Loan Proceeds
10) Refunds/Reimbursements to the Committee
1 I) Other Receipt Sources
I la) Interest on Bank Accounts
I lb) Contributions from Not -For -Profit Organizations
Ile) Outside Sources of Income
ltd) Legal Expense Fund - Other Sources
Ile) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
(CRO -125o)
(CRO -1250)
(CRO -1270)
(CRO -1265)
$
$
$ Z� '1 y y
$ Z
q V
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
12)TOTAL RECEIPTS (Add lines 5,6, 7, 8, 9, 10,1 la, l l b, l l c, l ld and l le
$
2q_7q,
$
291q.
1APENDITURES
13) Disbursements
13b) Contributions to Candidates/Political Committees (CRO -1310)$
13a) Operating Expenditures (CRO -1310)7$S
13c) Coordinated Party Expenditures (CRO -1310)$
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 -7510)
$
$
$
$
$
V
$
$
C
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, I6 and 17)
$
-uv V4
$
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$
'L00 DO
$
20()"o
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees (CRO -1330)
1) Outstanding Loans (incl. ones from other campaigns) (CRO -1430)
22) Debts and Obligations owed by the Committee T(CROa610)
UNION COUN
23) Debts and Obligations owed to the N FINA1162o)
24) Account Transfers Within the Committe RO-1720)
25) Administrative Supporttt� / (CR 1710)
26) Forgiven Loans nn CC CjEI V 01440)
27) 48 -Hour Notice Reports Sum (CRO -2220)
$
$
$
E:
$
$
$ $
$ $
$ $
28) Contributions to be Refunded
(CRO -1215)
$
js
: r,T#ff (iD;
NC State Board of Elections
August 2008
Contributions from Individuals Pg 1 of 2 Amendment
❑ Yes [3N.
Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used
1. Committee Full Name (and Fund if applimW
2. In Number
_
3. Contributor Information ❑ Add U Remove
. Full Name, Mailing Address & Phone
(include city, state, & zip)
IN. Job Title/Profession
d. Comments
v
apt r S. (/Q/q5
y06 Sian- br.
a
TitL(16 n � /pQ�I uC Za O 9
a Employer's Name/Specific Field
e,4,4$
e Electloo Stun to Date
Q0
2�
I. Prior
g. Account Code
h. Form of Payment
i. In -Kind Description
j. Dale (mnVdd/yyyy)
It. Amount
❑
/
$ 6 as
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state,&zip)
b. Job Thlen'rofession
d. Comments
n
C' )M61ICC �• �'SOLraa TC
?�SOZ Frnuw� R�I��N� i�(G(v
c. Employer Name/Specinc Field
�1SK /lIOC�
e. Election Sum to Date
C
$ 2 ly.b4
i'. Prior
g. Account Code
h. Form of Payment
i. In -Kind Descripdoa
o o F IA
j. Date (mm/dd/yyyy)
e a% '20z
it. Amount
$ Sao
ocqV
$ NPO
°
C�
Si rs� nitez
$ L/7-4-1
3. Contributor Information ❑ Add ❑ Remove
. Full Name, Mailing Address & Phone
iinciude city, state, & zip)
b. Job Title/Profession
d. Comments
II
jerr(J, -lsQi^4S
Cierra_
13Z6 evOfUe r,
(n r Z9
cmpoyers peBlees5
Field
f,tj wakq
j
e. Election Sum to Date
$ 5 q.75
I'. Prior
g. Account Code
1h.FormofPsymeant
1. In-Khrd Description
j. Date (mmlddlyyyy)
k Amount
❑
i
Z(
$ e75,
❑
$
❑
$
4. Total only this Page
$ 3 0. 3 3
5. Total of ALL CRO -1210 Pages UNION COUNTY
(This fine most be on line 6 ofDetaRed Summary Page CRO -1100) CAMPAIGN FINANCE
$ ,�I yy
jq 1.
1210
NC Stale Board of Ele&t�ys 2 0 2021 April 2007
RECEIVED
Contributions from Individuals Pg 2 of Amendment
11Yes ❑ No
Use This form to repot( individual contributions over 450 or contributions under S50 if Form CRO 1205 is not used
1. Committee Full Name (and Fund if applicable)2.
ID Number
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Nailing Address & Phone
(include city, slate, & zip)
C I
350 7 FI
�a haws, IJc 28ro�``
b. Job Title/Profession
, ,,,
d. Comments
c. Employ Neme/Specific Field
2
mSr� / �(ad
e. Election Sum to Date
$2�27/y.�9
. Prior
❑
g. Account Code
h. Form of Payment
i. In -Kind Description
. Date (mmtddlyyyy)
0 OZI
IL Amount
$ (I
❑
$
❑
3. Contributor Information ❑ Add ❑ Remove `-
$
a. Full Name, Nailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
c. Employer's Name/Specinc Field
e. Election Sam to Date
t'. Prior
❑
g. Account Code
h. Farm of Payment
1. In -Kind Description
j. Date (mm/dd/yyyy)
k Amount
$
❑
$
❑
S
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
( include city, state, & zip)
COUNTY
b. Job Title/Profession
d. Comments
c. Employer's Name/Specific Field
e. Election Sunt to Date
$
f.Prior
❑
g. Account Code
h. Form of P AI ption
j. Date (mm/dd/yyyy)
k Amount
$
2 0 2021
❑
$
❑
$
4. Total only this Page
$ 14 ,tt
5. Total of ALL CRO -1210 Pages
(This line must be on line d of Detailed Summary Page CRO -1100)
$�q ��
9V
CRO -1210 y'CStmc li,�at l ati]cnians April 2007
Amendment ....__.......
In -Kind Contributions Pg _L or _L ❑ Ws ❑ Nn
Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund.
I Ise CRO -1215 if In -Kind Contrihutions were or will be refunded within 7 days.
1. Committee Full Name (and Fund if applicable) 12.
ID Number___
3. Contributor Information ❑ Add ❑ Remove
a. Full Namc, \tailing Address & Phone
(include city, state, & zip)
b. Type of Contributor
c. Comments
ndividual
❑ Candidate
❑ Party
❑ PAC
❑Referendum
❑Other Receipt Source
G j erf�
_
IEVOIVe -Dr_
&//�r xrwr NC 7101
d. Election Sam to Date
/ c 7
$ / / .
. Description
f. Date (mm/ddtyyyy)
g. Fair Markel Amount
Lfikar
$
$
3. Contributor Information ❑ Add Remove
a. Full Name, Mailing Address & Phone
(include city, state, &zip)
b. Type of Contributor
c. Comments
Individual
date
01-
13 Party
❑PAC
❑ Referendum
❑ Other Receipt Source
/
C ((�de{1Cp� r ��id� iIXNLC, JZ
F1,,j,6. U( /aA6
d. Election Sam to Dale
$
,
e. Description
f. Date(mm/ddlyyyy)
g. Fair Market Amount
ax
zo Z(
$ S°,'D
//
6 Oet Gv
$ rc{�
$
3. Contributor Information ❑ Add ❑ Rcuwec
d. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Type of Contributor
c. Continents
L3 Individual
❑ Candidate
❑ Party
❑ PAC
13Referendum
❑ Other Receipt Source
c�e rtr.cejt7,ct�s, NL ZBlob
35-0-7 Ft 1
1
d. Election Sum to Date
$ ?1`,(t[
e. Description
Date (mnilddlyyyy)
g. Fair Market Amount
(�f.
Y
( NION GOONTYYE
t
$
4. Total only this Page $ �{
5. Total of ALL CRO -1510 Pages );
- (This line most he on line 17 of Detailed Summary Page CRO -1100)
CRO -1510 NC Stale Board of Elections December 2007
ZG 3b.s�
F -4-
.� 1 telt.)
27