Anderson,Gary_2021-PreElectionReportI Amendment
Disclosure Report Cover L1Yes E] 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
OMI
c. ID Number
e VI UNION COUNI Y
b. Mailing Address Onclude City, Aisle and Zip Code) CAMPAIGN FINANeEd.
Date Filed
02851 OCT 25 2021
/o-
�,/ RECEIVED
"'laIwoe AJ 02 1Jo
e. P1116ne Number
2. Report Year
3. Period Start Date (mm/dd/yy)
y)
4. Period End Date
S. Treasurer Full Name
mm/dd/ )
dna
7 aa�
Ln
o z
�QY
6. T e of Committee (C eck
9. T e of a or (check only one ty i ' re ort from one category)
Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
❑ Organizational
❑ Organizational
❑ Organizational
Independent ❑ ❑
Expenditure Joint Fundraiser
❑ Thirty-five day
Quarterly
E]Pre-referendum
❑ Legal Expense Fund
❑ Pre-primary
� Pre-election
❑ First
❑ Second
❑ Final
❑ Supplemental Final
7.T a of Fund (+f applicable, check one)
❑ "Booster Fund"
❑ Building Fund
❑ Pre -runoff
❑ Third
❑ Annual
Semi-annual
❑ Fourth
❑ Special
❑ Mid Year
Semi-annual
❑ Other:
❑ Year End
❑ Mid Year
10. $ ecial Report Name
❑ Final
❑ Special
❑ Year End
❑ Final
❑ Special
8. Number of Fundraisers this Report
Q
11. Account Information
11. Account Information
a. Financial Institution Full Na c
a. Financial Institution Full Name
b. Purpose
c. Account Code
b. Purpose
c. Account Code
Q
d. Period Begin Balance
d. Period Begirt Balance
$ O
$
CERTIFICATION
I certify that the Committee or Funo 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 commingled with prohibited or other non -disclosed funds. I further certify tha this report
is complete, Uimnd correct d that have been traped by the tate Board ElecOns.
(
/0
tried Name of Signer Signatur of Appointed Treasurer
at
FOR OFFICE USE OOLLIV
]] _
Date Received: aS 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:
mandatorytraining
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
Detailed Summar Amendment
Y E3 Yes ❑ No
Use this form to summarize all disclosure renortine limns and to total monctary information
. Co 'ttee Full ame (and Fund if applicable)
O+/
2*Type of Report
Start of 194tion Cycle: Januar) 1, a �"
Total this
Reporting Period
Total this
Election Cycle
4) Cash on Hand at Start
ti
$
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
11) Other Receipt Sources
Ila) Interest on Bank Accounts
11b) Contributions from Not -For -Profit Organizations
11c) Outside Sources of Income
l Id) Legal Expense Fund - Other Sources
Ile) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CR&1410)
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
$
$
5,ao o_12
$
$
0
$ 0$
$
$
$
$
$
$
O
$
$
$
$
Q
$
$
$
$
12)TOTAL RECEIPTS (Add lines 5.6.7. 9, 9.10.1 Ia.l lb.l lel Id and l le
$ ,60
.C�?
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO -1310)$
13b) Contributions to Candidates/Political Committees (CRO -1310)
13c) Coordinated Party Expenditures (CRO -1310)
14) Aggregated Non -Media Expenditures (CRO -1315)
15) Loan Repayments (CRO -1420)
16) Refund&%eimbursements from the Committee (CRO -1320)
17) In -Kind Contributions (CRO -1510)
$
'
O
$
—
$ _
$
—
$ —
$
—
$ _-
$
--
$
$
— -
$
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$ p
$
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$
�,
a
ADDITIONAL INFORMATION
20) Non -Monetary Gifts Given to Other Committees (CRO -1330)
21) Outstanding Loans (incl. ones from other campaigns) (CRO -1430)
22) Debts and Obligations owed by the Committee (CRO -1610)
23) Debts and Obligations owed to the Committee (CRO -1620)
24) Account Transfers Within the Committee (CRO -1720)
25) Administrative Support (CRO -1710)
6) Forgiven Loans (CRO -1440)
27) 48 -Hour Notice Reports Sum UNION COU Y2220)
8) Contributions to be Refunded CAI0PAIGN FIt6R,RiW)
$ —�
$
$
$ _
$
$
$
T
$
$
_
$
$
$
$
—'
CRO -1100 NC State Board of Elections August 2008
OCT 2 5 2021
RECEIVED
Contributions from Individuals P 1 nr Amendment
g _ r , ❑ Yes ❑ No
ike this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 i, nw !i,ed
1. Committee Full Name (and Fund if applicable)
2. ED Number
3. Contributorormafion ❑ Add ❑ Remove
a. Full Name, 1 ' mg Address & Phone
(include city, state, & zip)
^
2;ill >G
1� ,1 CIAY )e g I �y �,[
b. Job Tiae/Profession
d. Comments
a Employer's Neme/S/p'ecific Field
C,�P \
e. Election Sum to Date
f. Prior
°
g. Account Code
h. Form of Payment
i. In --Kind Description
J. Date (mm/dd/yyyy)
a
k Amount
$ 5.06
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip) /
�
✓�d�GO ✓L10 Y(/
J ip 2 �0 O) yl p�' / 6
b. Job Title/Profession
d. Comments
c. Employer's Name/Specific Field
Se1�
e. Election Sum to Date
$
f. Prior
❑
g. Account Code
h. Form f Payment
1. In -Kind Description
j. Date (mm/dd/yyyy)
,p
k Amount
_$ aa�
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
-
c. Employer's Name/Speciric Field
e. Election Sum to Date
$
f. Prior
❑
g. Account Code
It. Form of Payment
i. In -Kind Description
COUN
G jiv ;,IGN FINANCE
J. Date (mmldd/yyyy)
k Amount
$
°
OCT 2 5 202
$
❑
$
otal onl}'this Pageotal
of ALL CRO -1210 Pagesis line amsl be on line 6 of Detailed Summary Page CRO -1100)
F
CHH -1210 NUSlat. , .i_: t L'._: vui,, qpu� iin-
DisbursementsAmendment
Pg °f� El Yes ❑ No
Use this form to report expenditures from the committee for operating expenses, cone-mutions to candidate/political
committees and coordinated
1. Committee Full Name (and Fund if applicable) 2,-
,ID Number
410/t--
G, t
. T e of _ bursement (Please use se arate CRO -1310 orms or each a -o Disbursement. -
Operah e Expenses Contributions to Candidates/Political Conmuttees Coordinated Partv Expenditures
4. Payee Information ;_❑_ Add I❑ Remove -.
a. Full Name, Mailine Address &. Phone In Coordinated Committee Name d. Comments
(include city, state, & zip)
I �t
l e d 1v.4 , 1 n C. Level Registered (Specify)
'2 Federal C my:
v / JN [ v j,(J ❑ State uaicipality: e. Election Smn to Date
$
. Account Cade
g. Fo of Payment
In Purpose Code
i. Date ddlyyyy)
j. Amount
k Required Remarks
LO,$ J
4. Payee Information ——E] Add Add 0 Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
In Coordinated Committee -Name
d. Comments
C6l yv e q c'f o) d
c. Level Registered (Specify)
FederalC ty:
❑ State Municipality:
^l0
e. Eleetioh Sum to Date
Account CoddPayme
h. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
19.
$
$ O
4. Payee Information❑_ _ Add El Remove
a. Full Name, Mailing Address & Phone
(in a city, state, & zip)
b. Coordinated Committee Name
--
d. Comments
—
n
q Wt[t�$G (..�DK5L4kY,,t h
Jr. Level Registered (Specify)
LLc
l/
Federal runty:
❑ State Municipality:
e. Election Sum to Date
�'8 uJ L l o
$
. Account Code g. F r of Payme
In Purpose Codei.
Date (nm>/ d/yyyy)
j. Amount
k Required Remarks
2
$l o
�;
s
,
5. Total only this Page $
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) $
(This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm).
(This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures)
7. Purpose Codes (List detailed expenditure code in (h) above) OCT 2 5
A* - Media B* - Printing C* - Fundraising D - To Another Candidate
E - Salaries F* - Equipment G - Political Parry H* - Holding Public Offic R ` /
I - Postage J - Penalties K* - Office Expenses V
O* Other P Q* - Donation to Le al Ex ense un
* Codes re vire detailed a lanation in re aired remarks field k
7R -31o 11 c._._ o ___1—. _.
December 2009
l
IS/
DisbursementsAmendment
Pg of ❑ Yes ❑ No
Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political
committees and coordinated arty ex enditures
1. Committee Full Name (and Fund if applicable) -
2. ED Number -
I&A, AL4�eAlAbrj ko V �0 e C
bursemeut '(Please use se_ arate CRO -1310 orms or ea o Disbursement.
Ecpenses Contnbotions to Candldat,,ToLucal Committees Coordinated Party Expen!!n:'
rPayyeeormation ❑ Add 'I❑_ Remove
. Mai)ing Address .�- Phone b. Coordinated Committee Named. Comments
n,ate, /&/zip) t ,� --- -
tN t f� li 0 6(�J L3, n , L. c. Level Registered (Specify)
,1 Federal �nty:
0 �.J ❑State bfunicipality: e. Election Sum to Date
�o�t enc i ,
, IV e
. Account Code g. Form of eo[ . Purpose Code i. Da a (mm/ yyyy) j- Amount marks
e $ DTJ1Y1
i�'
$ LI
4. Payee Information i_❑ Add I❑ Remove
a. Full Name, Mailing Address & Phone
(include city,, state, & zip)
b. Coordinated Committee Name
d. Comments
-
I
, i
Flt O �d �✓ ctoleki ei
c. Level Registered (Specify)
Federal C ty:
❑ State unicipality:
e. Election Sto Date
um
$
. Account Code
g. Fo m
f Paymen
h. Purpose Code
.Date ( dd/yyyy)
j. Amount
k. Required Remarks
$ 9.
t
4. Payee Information El Add
QRemove
a. Full Name, Mailing Address &Phone
(include city, state, & zip)
b. Coordinated Committee Name
d. Comments
-- -- -
vli _ ry %t �, n r
•rlPn� v �V/ J
a3 O / OM CO V--dW
t 111---0 4 � �� ii 0
c. Level Registered (Specify)
Federal —❑ my:
❑ State Municipality:
e. Election Sum to Date
$
. Account Code
g. Form of Payment
h. Purpose Code
i. Date mnddd/yyyy)
j, Amount
it. Required Remarks
9 , �4 Isi
1 .7
C
5. Total only this Page I
6. Total of ALL CRO -1310 Pages
$
$
(This line goes in line 13a of Detailed Summary PageCR0-1100 if Operating Expenses)
(This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm)
(This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures)
7. Purpose Codes (List detailed expenditure code in (h) above)
A* - Media B* - Printing C* - Fundraising D - To Another Candidate , ! - i
E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses
I* Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O Other
*explanation— -
Codes re re detailed in re a— -rem-arks remarks— fiel—d k
CRO -1310
December 2009
rS
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