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Becker, Rick_2019-MidYearAmendment Disclosure Report Cover ❑ Yes ® No------- Use eUse 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 c. ID Number Committee to Elect Rick Becker FJM29B It. Mailing Address (include City, State and Zip Code) d. bate Filed 6603 Sadler Rd 07/16/2019 Waxhaw, NC 28173 e. Phone Number (704)843-5870 2. Report Year 3. Period Start Date (mru/dd/yy) 4. Period End Date 5. Treasurer Full Name mm/d4/ Frederick Becker III 2019 01/01/2019 06/30/2019 6. Type of Committee Check One 9. Type of Report (check only one type of report om one category) ® Candidate Campaign ❑ Party Municipal State/County Referendum ❑ Organizational ❑ Organizational ❑ Organizational ❑ PAC ❑ Referendum Independent ❑ Joint Fundraiser ❑ Expenditure ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ IRgal Expense Fund ❑ ❑ Pre-primary Pre-election ❑ First ❑ Second ❑ Final ❑ Supplemental Final 7. Type of Fund (if 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. Special p Re ort Name ❑ ❑ Final Special ❑ Year End ❑ Final ❑ Special 8. Number of Fundraisers this Report 0 11. Account Information 11. Account Information a. Financial Institution Full Name a. Financial Institution Full Name First National Bank b. Purpose c. Account Code b. Purpose c. Account Code General Campaign 1 J U L 16 2 U 19 d. Period Begin Balance d. Period Begin Balance Account ion Go. Elections $ 304.47. :,- $ 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 the N,C�State Bo�Id of�}lections. Frederick Becker 1II 07/16/2019 Printed Name of Signer Signature of Appointed Treasurer Date FOR OFFICE USE ONLY — Delivery Method Date Received: ] Employee: ❑ Normal Mail ❑ Registered Mail Date Postmarked: Employee: ® Hand Delivered ❑ Electronically Filed Date Scanned: 1 9 Employees ❑ 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-210OA-E to make committee changes. CRO -1000 NC Stale Board of Elections August 2008 Amendment Detailed Summary ❑ Yes ® No Use this form to summarize all disclosure reoortine forms and to total monetary information. 1. Committee Full Name and Fund if applicable) _,T e of Report 3, ID Number Committee to Elect Rick Becker Mid -Year FJM29B Start of Election Cycle: January 1, 2019 Total this Reporting Period Total this ))lection Cycle 4) Cash on Hand at Start $ 304.47 $ 304.47 5) Aggregated Contributions from Individuals (CRO -1205) $ $ 6) Contributions from Individuals (CRO -1210) $ 5.00 $ 5.00 .... 7) ._. _........_ . .......... ........... --- _..... Contributions from Political Party Committees (CRO -1220) $ $ 8) 9) Contributions from Other Political Committees .......... Loan Proceeds (CRO -1230) - (CRO -1410) $ $ $ $ 10) 11) Refunds/Reimbursements To the Committee Other Receipt Sources Ila) Interest on Bank Accounts (CRO -1240) (CRO -1250) $ $ $ $ Ilb) Contributions from Not -for -Profit Organizations (CRO -1250) $ $ 11c) Outside Sources of Income (CRO -1250) $ $ lld) Legal Expense Fund - Other Sources (CRO -1270) $ $ 11 e) Exempt Purchase Price Sales (CRO -1265) $ $ 12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10, Ila, 116, 11c, Ild and Ile) $ 5.00 $ 5.00 EXP 13) Disbursements 13a) Operating Expenditures (CRO -13,10) $ $ 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) Refunds/Reimbursements From the Committee (CRO -1320) $ $ 17) -- — ——...... 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 saes 4 and 12 together, thea subbact line 18) AD 20) Non -Monetary Gifts Given to Other Committees (CR01330) 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 FTtn t (CRO 1720) 25) Administrative Support(CRO-1710) 26) Forgiven Loans gut'... 2D1� (CRO -1440) 27) 48 -Hour Notice Reports S nlon (:o. Mections (CRO -2200) 28) Contributions to be Refunded (CR04215) $ $ $ $ $ $ $ $ 309.47 3185.01 $ $ $ 309.47 $ $ $ $ CRO -1100 NC State Board of Elections August 2008 Amendment Contributions from Individuals Pg I of 1 ❑ _ Yea_ _® No l 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 applicable) 2. ID Number Committee to Elect Rick Becker FJM29B 3, Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Municipal Finance Officer Frederick Becker III 6603 Sadler Rd Waxhaw, NC 28173 c. Employer's Name/Specifrc Field Town of Mineral Springs Municipal Government e. Election Sum to nate f, Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k Amount ❑ 1 Cash 01/04/2019 $ 5.00 ❑ $ ❑ $ 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/Specific Field e. Election Sum to Date $ f. Prior g. Account Code h. Form of Payment 1..In-Kind Description J. Date (mm/dd/yyyy) - k Amount ❑ $ ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments i, p JUL 16 2019 c. Employer's Name/Specific Field e. Election Sum to Date $ f. Prior g. Account Code h. Form of Payment i. In -Kind Description J. Date (mm/dd/yyyy) k Amount ❑ $ ❑ $ ❑ $ 4. Total only this Page $ 5.00 5. Total of ALL CRO -1210 Pages $ 5.00 (This line muni bo on line 6 ofDelailed Sammary Page LR0.1100) CRO -1210 NC State Board of Elections April 2007 �_ _.. Amendment Outstanding Loans Pg 1 of 3 ❑ ve5 ® Nn Use this form to report any outstanding loans received during a previous reporting period and until the loan is paid in full. 1. Committee Full Name (and Fund if applicable) ti. ID Number ' Committee to Elect Rick Becker FJM29B 3. Lender Information ❑ Add ❑ Remove a. bull Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Woodworker Candidate Frederick Becker III 6603 Sadler Rd Waxhaw, NC 28173 e. start Date (mm/dd/yyyy) c. Employer's Name/Specific Field 04/07/2000 Self f. End Date (mm/dd/yyyy) g. Rate It. Security Pledged i. Original Loan Amount j. Remaining Loan Balance 0 % None $ 1,380.01 $ 1,380.01 k bull Name of Lending Institution 1. Loan Number 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Finance Offier Candidate Frederick Becker III 6603 Sadler Rd Waxhaw, NC 28173 e. Start Date (mmldd/yyyy) c. Employer's Name/Specific Field 10/27/2011 Town of Mineral Springs f. End Date (mm/dd/yyyy) g. Rate h. Security Pledged i. Original Loan Amount j. Remaining Loan Balance 0 %n None $ 500.00 $ 500.00 k: Full Name of Leading Institution 1. Loan Number 3, Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Finance Officer Candidate Frederick Becker III 6603 Sadler Rd Waxhaw, NC 28173 (r�(CJ J',��%[� JUL 16 2019 N e. Start Date (mm/dd/yyyy) c. Employer's Name/Specific Field' 2/28/2013 Town of Mineral Springs LEnd Date (mm/dd/yyyy), g. Rate It. Security Pledged 1. Original Loan Amount J. Remaining Loan Balance 0 9n None $ 5.00 $ 5.00 k Full Name of Lending Institution 1. Loan Number 4. Total only this Pae $ 1,885.01 5. Total of ALL CRO -1430 Pages (This line must he on line 21 ofDetni/ed Summary Page CRO -1100) - $ 3,085.01 CRO -1430 NC Slate Board of Elections December 2007 Amendment Outstanding Loans Pg z of 3 ❑ Yes ® No Use this form to report any outstanding loans received during a previous reporting period and until the loan is paid in full. 1. Committee Full Name and Fund if applicable) 2. ID Number Committee to Elect Rick Becker FJM29B 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state,& zip) b. Job Title/Profession d. Comments Finance Officer Candidate Frederick Becker III 6603 Sadler Rd Waxhaw, NC 28173 e. Start nate (mm/ad/yyyy) c. Employer's Name/Specific Field 09/27/2013 Town of Mineral Springs f. End Date (mm/dd/yyyy) g. Rale h. Security Pledged 1. Original Loan Amount J. Remaining Loan Balance 0 % None $ 200.00 $ 200.00 k Full Name of Lending Institution 1. Loan Number 3, Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone _ (include city, state, & zip) b. Job 1$le/Profession d. Comments Finance Offier Candidate Frederick Becker III 6603 Sadler Rd Waxhaw, NC 28173 e. start Date (mm/dd/yyyy) c. Employer's Name/Specific Field 10/25/2013 Town of Mineral Springs E End Date (mm/dd/yyyy) g. Rate h. Security Pledged J. Original Loan Amount J. Remaining Loan Balance 0 9/ None $ 200.00 $ 200.00 k Full Name of Lending Institution 1. Loan Number 3, Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Finance Officer Candidate Frederick Becker III 6603 Sadler Rd L>� P' Waxhaw, NC 28173 6ZOi o, E12r; e. Start Date (mm/dd/yyyy) c. Employer's Name/Specific Field 07/14/2015 Townof Mineral Springs f. End Date(mm/dd/yyyy) g. Rate h. Security Pledged is Original Loan Amount j. Remaining Loan Balance 0 % None $ 500.00 $ 500.00 L Full Name of Lending Institution 1, Loan Number 4. Total only this Pae $ 900.00 5. Total of ALL CRO -1430 Pages (This line must be on line 21 of Detailed Summary Page CRO -1100) $ 3,085.01 CRO -1430 NC State Board of Elections December 2007 Amendment Outstanding Loans Pg , of 3, ❑ _ Yes ® No J Use this form to report any outstanding loans received during a previous reporting period and until the loan is paid in full. 1. Committee Full Name (and Fund if applicable) 2. In Number Committee to Elect Rick Becker FJM29B 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, &zip) b. Job Title/Profession d. Comments Finance Officer Candidate Frederick Becker III 6603 Sadler Rd Waxhaw, NC 28173 e. Start Date (mm/dd/yyyy) c. Employer's Name/Specific Field 10/15/2015 Town of Mineral Springs G End nate (mm/dd/yyyY) g. Rate h. Security Pledged L Original Loan Amount j. Remaining Loan Balance 0 °/a None $ 300.00 $ 300.00 k Full Name of Lending Institution 1. Loan Number 3, Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Finance Officer Candidate Frederick Becker III 6603 Sadler Rd Waxhaw, NC 28173 e, Start Date (mm/dd/yyyy) c. Employer's Name/Specific Field 10/30/2015 Town of Mineral Springs f. End Date (mm/dd/yyyy) g. Rate h. Security Pledged L Original Loan Amount J. Remaining Loan Balance 0 °/a None $ 100.00 $ 100.00 k Full Name of Lending Institution 1. Loan Number 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, stalIte,& zip) b. Job Title/Profession d. Comments JUL 1 6 Z019 Union COY r`_i ect i p n , e. Start Date (mm/dd/YYYY) C. Employer's Name/Specific Field L End nate (mm/dd/yyyy) g. Rate h. Security Pledged i. Original Loan Amount j. Remaining Loan Balance k Fail Name of Lending Institution I. Loan Number 4, Total only this Pae $ 400.00 5. Total of ALL CRO -1430 Pages (This line must he on line 21 of Detailed Summary Page CRO -1100) $ 3,185.01 CRO -1430 NC State Board of Elections December 2007