Anthony, Surluta_2021-02-Org-DisclosureDisclosure Report Cover a t o No
Use this form for general report and committee information, must be signed and submitted along with other detailed farms.
Do not use this form to undate information.
1. Committee Information
a. Full Name
c ID Number
Cornmv'ftec -to 0C-C--T-L- tSi&rlu r B. AWthomy
XJM wo-�
b. Naffing .Address (include Ck); Sk to and 7ip Code)
d. Dre FBdI
5o8 157. TQII-cyr-n4
l✓ I. o n rye l N L
e. Phone Number
2. Report Year
3. Period Start Date
4. Period Fad Elate
5. Treasurer Frill Name
anal
10715-a1
C9'? - 9,5 - al
I Erni( M• t-6%nij
• of Committee Check One)
9. Type
of Report (check only one type of reportfrom one category)
Candidate Campaign Pavy
M palRe&re�m
�y
❑ PAC ❑ Referendum
�rgamranonal
Orgaavatwnal
_
Organizational
13 Independent Expenditure ❑ Joint Fundraiser
❑ Ihir[y-five dayQuarterly
❑Pre -referendum
❑ Legal Expense Fund
❑ Pm -primary
❑ Finn
❑ Final
❑ Pre-election
❑ Pre -runoff
Semi-annual
❑ Second
❑ Third
❑ Fourth
❑ Supplenx-ntal Final
❑ Annual
❑ Special
. Type of Fuld (if oppheable, check ate)
❑ Booster Fund
❑ Building Fund
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
IR. Special Report Name
0 Other:
10 Final
❑ Special
❑ Year End
❑ Final
8. Number of Fundraisers this Report
❑ Special
11. Account Information
11. Account Information
a. Finamial bridtiNou Fua Name
FluaaeW taadmtYn FW
rl F A 'Tf li r d
MPAIGN FINA
. Purpose
c Aeramt Code
IL Purpose
Code
'4(f T1
'Q EC F—
Campo, yn
f�
d. FW" Bei Rabum
F;QBegin Rahmor
s
$
7 (f s
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CERTIFICATION
I 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 ate commingled with prohibited or other non-disdosed finds. 1 further certify that this
report is complete, true and correct and that 1 have been framed by the NC State Board of Elections.
NlC'G'nIL0 8-3[-�{
Pnntaft Name of Signer Si auae OTA;red Treasurer Ione
OR OFFICE USE ONLY
Delivery Method
Date Received: Employee: ❑ Normal Mail
Date Postmarked: Employee: ❑ Registered Mail
❑ Hand Delivered
Date Scanned: Employee: ❑ Electronically Filed
Date Data Entered: Employee: E3 Signer has not receivedmandatory trainio
Please Note: This form cannot he 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-210oA-E) to snake committee changes.
CRO., 000 NC State Bond o(Elechom Au Don '_nua
l,J
Detailed SummarAmendment
y ❑ les ❑ No
I Ne. this form to summarize all disclosure renortine forms and to total monetary information
1. Committee Fail Name (and Fund if ap llcab e)
2. of Report
3. ID Number
X SM W63
Commi tfee -Iv &pct (- Sur f;2 e
Q aniZ4,HM4,L
Start of Election Cycle: January 1, a
Total this
Re Period
Total this
Election Cycle
4) Cash on Hand at Start
$
S
RECEIPTS
5) Aggregated Contributions from Individuals (CRO -1205)
6) Contributions from Individuals (CRO -1210)
7) Contributions from Political Party Committees (CRO -1210)
8) Contributions from Other Political Committees (CRO -1230)
9) Loan Proceeds (CRO -1410)
10) Refunds/Reimbursements to the Committee (CRO -1240)
11) Other Receipt Sources
I la) Interest on Bank Accounts (CRO -1250)
llb) Contributions from Not -For -Profit Organizations (CROa250)$
Ile) Outside Sources of Income (CRO -1250)
l ld) Legal Expense Fund -Other Sources (CRO -1220)
Ile) Exempt Purchase Price Sales (CRO -1265)
$
$
S
$
S
$
S
$
S
$
$
$
S
$
S
$
5
$
ti
12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9. 10,11 a, I I M lc, I Id and I le)
$
S
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO -1310)
13b) Contributions to Candidates/Political Conunittees (CRO -1310)
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 -1510)
$
$
S
$
S
$
S
$
S
$
S
$
$
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$ Zr
$
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$
S
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees (CRO -1330)
1) Outstanding Loans (incl. ones from other campaigns) (CRO -1430)
2) Debts and Obligations owed by the Committee (CRO -1610)
3) Debts and Obligations owed to the Committee (CRO -1620)
24) Account Transfers Within the Committee (CRO -1120)
5) Administrative Support (CRO -1710)
6) Forgiven Loans (CRO -1440)
48 -Hour Notice Reports Sum (CRO -2220)
$
$
$
$
$
$ 3 �
$ $
$
Contributions to be Refunded (CRO -1215)
$ $
CRO -1100
NC State Board of Elections
August 2008