Atkinson,Jeff_2021-Year-endAmendment
Disclosure Report Cover ❑ Yes ® 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.
a. Full Name
c. ID Number
The Vote Jeff Atkinson Committee
ATK118
It. Mailing Address (include City, State and Zip Code)
it. Date Filed
8509 Whitehawk Hill Rd
01/28/2022
Waxhaw, NC 28173
JAN 2 82022
e. Phone Number
(704) 641-4491
Union CO. Board Of
2. Report Year
3. Period Start Date (mm/dd/yy)4.
Period End Dated/yy)
5. Treasurer Full Name
mm/d
Baxter Ware Starnes
2021
07/01/21
12/31/21
b. Type of Committee Check One
9. TyN
of Report check only
one type of report ow one cute ory
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
❑
Organizational
❑ Organizational
❑ Organizational
Independent ❑ ,loin Fundraiser
❑ Expenditure
❑
Thirty-five day
Quarterly
❑ Pre -referendum
Legal Expense Fund
❑
Pre-primary
❑ First
❑ Final
'(jJ'airialwabk, check om)
❑ "Booster Fund"
❑
Preelection
❑ Second
❑ Supplemental Final
❑ Building Fond
❑
Pre-mnoff
❑ Third
❑ Annual
Semi-annual
❑ Fourth
❑ Special
❑
Mid Year
Semi-annual
❑ Other:
❑
Year End
❑ Mid Year
10. Special Report Name
❑
❑
Final
Special
® Year End
❑ Final
❑ Special
8. Number of Fundraisers this Report
ii
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
Wells Faro Bank
It. Purpose
c. Account Code
It. Purpose
c. Account Code
Checking
1
Account for
Committee
it. Period Begin Balance
d. Period Begin Balance
$ 52.52
$
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 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 theta, Board f Election
Baxter Ware Starnes
Dl '28 a2c AO—
Printed Name of Signer
ignature of Appointed Treasurer
6ale
FOR OFFICE USE ONLY
Date Received: ��
Employee:
ql(��El
Delivery Method
Normal Mail
Date Postmarked:
Employee:
Registered Mail
Hand Delivered
Date Scanned:
Employee:
Electronically Filed
� f
❑ Signer has not received
mandatory training
Date Data Entered:
Employee:
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
%nlendmenl
Detailed Summary ❑ ,es ® No
Use this form to summarize all disclosure reporting forms and to total monetary information.
1. Committee Full Name and Fund if applicable)
2. Type
of Report
3. ID Number
I he
Vote Jeff Atkinson Committee
Year End
ATK 118
Start of Election Cycle: January 1, 2021
Total this
Reporting Period
Total this
Election Cycle
4)
�)
6)
7)
8)
9)
10)
11)
Cash on Hand at Start
Aggregated Contributions from Individuals
Contributions from Individuals
Contributions from Political Party Committees
Contributions from Other Political Committees
Loan Proceeds
Refunds/Reimbursements To the Committee
Other Receipt Sources
I la) Interest on Bank Accounts
11h) Contributions from Not -for -Profit Organizations
lie) Outside Sources of Income
I ld) Legal Expense Fund— Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1130)
(CRO -1410)
(CRO -1240)
(CR0-125
(CRO -1150)
(CRO -1250)
(CRO-1274kio
(CRO -1265)
$
$
52.52 $
$
52.52
$ $
$ $
$ $
$ $
$ $
$
$ $
n
8 $
Co. Board of Elections $
$ $
12)
13)
14)
15)
16)
17)
TOTAL RECEIPTS (Add laws s, 6, 7, s, 9, 10, Ila, 11b, 11c, 1ldandIle)
Disbursements
13a) Operating Expenditures (CRO -1310)
13b) Contributions to Candidates/Political Committees (CRO -1310)
13c) Coordinated Party Expenditures (CRO -1310)
Aggregated Non -Media Expenditures (CRO -1315)
Loan Repayments (CRO -1420)
Refunds/Reimbursements From the Committee (CRO -1320)
In -Kind Contributions (CRO -1510)
$
$
$ $
$ $
$ $
$ $
$ $
$ $
$ $
18)
TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$
$
19) Cash on Hand at End (Add lbw 4 ail 12 together, then subtract lire 18)
Al)
20) Non -Moneta r) G i As 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)
26) Forgiven Loans (CRO -1440)
27) 48 -Hour Notice Reports Sum (CRO -2220)
28) Contributions to be Refunded (CRO -1115)
$
52.52
$
52.52
$
$
$
$
$
$ $
$ $
$ $
$ $
CRO -1100 NC State Board of Elections August 2008