Becker, Rick_2019-PreElectionAmendment
Disclosure Report Cover ❑ Yea ® 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
c. ID Number
Committee to Elect Rick Becker
FJM29B
IL Mailing Address (include City, State and Zip Code)
d. Date Filed
6603 Sadler Rd
10/23/2019
Waxhaw, NC 28173
e. Phone Number
(704) 843-5870
2. RepW Year". Period Start Date (mm/ad)yy)
d" Period End Date
5, Treasurer Full Name
mm/dd/vv
2019 2019
I11 21 2019 Frederick 13cckcr 111
6. lype of Committee Check One
9. lype
of Report check only one type of iTipport
ora one category)
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
❑
Organizational
❑ Organizational
❑ Organizational
Independent
❑ Expenditure E]Joint Fundraiser
E]Thirty-five
day
Quarterly
❑ Pre -referendum
Legal Expense Fund
❑
®
Pre-primary
Pre-election
❑ First
❑ Second
❑ Final
❑ Supplemental Final
❑ "Booster Fund"
❑ Building Fund
❑
Pre-mnoff
❑ Third
❑ Annual
Semi-annual
❑ Fourth
❑ Special
❑
Mid Year
Semi-annual
❑ Other:
❑
Year End
❑ Mid Year
10. 9pecial ReporVIIW
❑
❑
Final
Special
❑ Year End
❑ Final
❑ Special
8. Number ofFaodraisers this Report
0
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
First National Bank
It. Purpose
c. Account Code
b. set
a Account Code
General
1
Campaign
� � � � 20,19
d. Period Begin Balance
d. Period Begin Balance
Account
Union Co. Board of Elections
$ 49.80
$
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 NC State Board of EI ctions.
Frederick Becker IN
��
10/23/2019
Printed Name of Signer
Signature of AppointATneriturer
Date
FOR OFFICE USE ONLY
Delivery Method
Date Received:
40-
Employee:
[-]Normal Mail
E] Registered Mail
Date Postmarked:
Employee:
®Hand Delivered
Date Scanned:
Employee:
E] Electronically Filed
❑ 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
Amendment
Detailed Summary YeaNo
Use this form to summarize all disclosure reporting forms and to total monetary information.
nd if applicable)
Committee FLRickBecTr
Committee to E
to
2. T of Report
Prc-Election
FIM29B
Start of January 1, 2019
Total this
Re or[in Period
'total this
Election C cle
4)
5)
6)
7)
8)
9)
10)
11)
Cash onH
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
Ila) Interest on Bank Accounts
11b) Contributions from Not -for -Profit Organizations
11c) Outside Sources of Income
lid) Legal Expense Fund — Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
$
$
49.80
$
$
304.47
$ 1200.00
$
1205.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
12)
13)
14)
15)
16)
17)
TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10, Ila, ll b, 116 11 d and Ile)
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)
Ref tnds/Reimbursements From the Committee (CRO -1320)
In -Kind Contributions (CRO -1510)
$
1200.00
$
1205.00
$ 668.01
$
927.68
$
$
$
$
$
$
$
$
$
$
$
$
18)
TOTAL EXPENDITURES (Add lines 13a, 13b, 13g 14, 15, 16 and 17)
$
668.01
$
927.68
19)
Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18)
$
581.79
$
581.79
20)
21)
22)
23)
24)
25)
26)
27)
28)
Non-Monetar) Gifts Given to Other Committees
Outstanding Loans (incl. ones from other campaigns)
Debts and Obligations owed By the Committee
Debts and Obligations owed To the Committee
Account Transfers Within thRTT'X l� I V E D
Administrative Support `v f�
Forgiven Loans OCT 2 3 2019
48 -Hour Notice Reports Smbnlon Co. Board of ElecWnS
Contributions to be Refunded
(CRO -1330)
(CRO -1430)
(CRO -1610)
(CRO -1620)
(CRO -1720)
(CRO -1710)
(CRO -1440)
(CRO -2200)
(CRO -1215)
$
$
$
$
3185.01
54.60
$
$
$
$
$
$
$
$
$
CRO -1100 NC State Board of Elections August 2008
Amendment
Contributions from Individuals Pg t or 1 ❑ Yes ® No
Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used
Committee to Elect Rick Becker
3. C o
2. ID Number
FJM29B
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
It. Job Tine/Profession
d. Comments
Municipal
Finance Officer
(Candidate)
e. Election Sum to Date
Frederick Becker III
6603 Sadler Rd
Waxhaw, NC 28173
a Employer's Name/Specific Field
Town of Mineral Springs
Municipal Government
$ 1205.00
E Prior
g. Account Code
It. Form of Payment
I. In -Kind Description
j. Date (mm/dd/yyyy)
k. Amount
❑
1
Check #776
10/11/2019
$ 1200.00
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Tine/Profession
d. Comments
–
e. Election Sum to Date
c Employer's Name/Specific Field
I. Prior
g. Account Code
h. Form of Payment
I. In -Kind Description
j. Date (mm/dd/yyyy)
k Amount
❑
$
❑
$
❑
$ —
3. Contributor Informatign ; ❑ Add ❑ ., Remove
a. Full Name, Mailing Address & Phone
(include city, stale, & A1 I ECEIVEn
b. Job Tine/Profession
d. Comments
f1
C" L J 2'019
GSI T
Union Co. Board of EleClions
a Employer's Name/Specific Field
e. Election Sum to Date
E Prior
g. Account Code
It. Form of Payment
1. In -Kind Description
J. Date (mm/dd/yyyy)
k Amount
❑
$
❑
$
❑
$
4. Total only this Page $ 1200.00
5. Total of ALL CRO -1210 Pages a 120000
(This line must be on fine 6 of Detailed Summary Page CRO -1100)
CRO -1210 NC State Board of Elections April 2007
Amendment
Disbursements Pg i of 1 ❑ Yes ® No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
committees and coordinated party expenditures
e and F Number
Committee to Elect Rick Becker FJM29B
3, Type of>Nebursement (PleaMiese 7 me
® operating Fxperaca ❑ Contrihu Gans to CLndidute. Pulincal ( LmmillecN ❑ oordmaled Party Expenditures
4. Payee Information M Add Remove
a. Full Name, '.hailing Address & Phone
include city, stat & a
b. Coordinated Committee Name
d. Comments
USPS
5912 Waxhaw Hwy
Mineral Springs, NC 28108
(704) 843-3713
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ state ® Municipality:
e. Election Sum to Date
$ 572.00
L Account Code
g. Form of Payment
Is. Purpose Code
L tate (mm/dd/yyyy)
j. Amount
Ir. Required Remarks
1
Ck #984
1
10/11;2019
$572.00
Postage for
Flyers
$
4. Pitlymbdermation El, Add El Remove
a. Fug Name, Mailing Address & Phone
include city, stat & a
It. Coordinated Committee Name
d. Comments
Office Max
1030 W Roosevelt Blvd
Monroe, NC 28112
(704) 226-9977
c. Level Registered (Specify)
❑ Federal ❑ County:
State ® Municipality:
e. Election Sum to Date
$ 96.01
L Account Code
g. Farm of Payment
Is. Purpose Code
i. Date (mm/dd/yyyy)
j• Amount
L Required Remarks
I
Ck #985
A
10/12/2019
$96.01
Printing
Flyers
4. Payee Information Add Remove
a. Full Name, Mailing Address & Phone
include city,state, & zip)
b. Coordinated Committee Name
d. Comments
RE C E- I V 4 Et D
OCT 2 3 2119
Union Co. Board of Elections
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State Municipality:
e. Election Sum to Date
$
E Account Code g. Form of Payment IL Parpose Code
L Date (mm/ddtyyyy)
j. Amount
L Required Remarks
$
S
$. TOtaI onlyAS 668.01
6. Total of ALL CRO.1310 Pages
('This line goes in line l3a of Detailed Summary Page CRO -1100 if Operating Expenses)
(This line goes in line 13b of Detailed Summary Page CRO -1100 ifContrib to Candidates/Political Comm) $ 668.01
(This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Pant/ Expenditures)
7. Purpose Codes List detailed expenditure code in above
A* - Media B* - Printing C* - Fundraising D - To Another Candidate
E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses
I - Postage J - Penalticv K* - Office Expenses O* - Other
* Codes require detailed explanation in required remarks Held k
CRO -1310 NC State Board of Elections April 2007
aIII rndm,
Outstanding Loans Pg I of 3 ® 'I ❑
Use this form to report any outstanding loans received during a previous reporting period and until the loan is paid in full.
I. Committee FuH Name and Fund if applicable)
2. ID Number
Committee to Elect Rick Becker
PJ%12913
3. Lender Information ❑ Add ❑ Remove
a. Full 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)
a Employer's Name/Specific Field
04/07/2000
Self
f. End Date (mm/dd/yyyy)
g. Rate
h. Security Pledged
1. Original Loan Amount
J. Remaining Loan Balance
0 %
None
$ 1,380.01
$ 1,380.01
k Full Name of Leading Institution
1. Loan Number
3. Leader 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 (mm/dd/yyyy)
c Employer's Name/Specific Field
10/27/2011
Town of
Mineral Springs
L End Date (mm/dd/yyyy)
& Rate
k Security Pledged
L Original Loan Amount
J. Remaining Loan Balance
0 %
None
$ 500.00
$ 500.00
L Foil Name of Lending Institution
1. Loan Number
3. Lender Information ❑ Add ❑ Remove
a. Full Name, flailing Address & Phone
(include city, state, & zip)
b. Job Tide/Profession
d. Comments
Finance Officer
Candidate
Frederick Becker IU_ .._. r r I Y C D
6603 Sadler Rd ` ;V e l t— Y L
Waxhaw, NC 28173 2 3 2019
GCT
Union Co. Board of Elections
a start Date (mm/dd/yyyy)
c. Employer's Name/Spedac Field
2!28/2013
Town of
Mineral Springs
L End Date (mm/dd/yyyy)
g. Rate
It. Security Pledged
L Origiml Loan Amount
j. Remaining Loan Balance
0 ya
None
$ 5.00
$ 5.00
k Full Name of Leading institution
1. Loan Number
4. Total only this Pae _•
$ 1,885.01
5. Total of ALL CRO -1430 Pages
(This line mast be on lute 21 of Detailed Summary Page CRO -1100)
_
S 3,185.01
CRO -1430 ',r ti,, R..:vd t,f bDecember 2007
Outstanding Loans
Amendment
Pg 2 of 3 ® Yes ❑ No
Use this form to report any outstanding lams received during a previous reporting period and until the loan is paid in full.
1. Committee Frill Name and Fund ifs licable)2. m Number
Committee to Elect Rick Becker Gllv1_1913
3. Lender Information ❑ Add ❑ Remove
a. Fall Name, Mailing Address & Phone
(include city, state, & rip)
b. Job Title/Profession
d. Comments
Finance Officer
Candidate
Frederick Becker BI
6603 Sadler Rd
Waxhaw, NC 28173
e. Start Date (mm/dd/yyyy)
a Employer's Name/Specific Field
09/27/2013
Town of
Mineral Springs
L End Date (mm/dd/yyyy)
g. Rate
It. Security Pledged
L Original Loan Amount
j. Remaining Loan Balance
0 %
None
$ 200.00
$ 200.00
L 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 Titie/Profession
d. Comments
Finance Offier
Candidate
Frederick Becker III
6603 Sadler Rd
Waxhaw, NC 28173
e. Start Date (mmidd/yyyy)
c Employer's Name/Specific Field
10/25/2013
Town of
Mineral Springs
L End Date (mm/dd/yyyy)
g. Rate
b. Security Pledged L Original Loan Amome
J. Remaining Loan Balance
0 %
None
$ 200.00
$ 200.00
k. Full Name of Lending Institution
L Lem Number
3. Lender Information ❑ Add
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Joh Title/Profession
d. Comments
Finance Officer
Candidate
Frederick Beckelrtll•I . !' L U
6603 Sadler Rd t ' ' ` J t'
Waxhaw, NC 28173 OC 12 3 2019
Union Co. Board d Elections
e. Start Date (mm/ddlyyyy)
c. Employer's Name/Specific Field
07/14/2015
Town of
Mineral Springs
L End Date (mm/dd/yyyy)
g. Rate
h. Seeurity Pledged L Original Loan Amount
j. Remaining Loan Balance
0 % I
None $ 500.00
$ 500.00
L Fug Name of Leading Institution
I. Loan Number
4. Total only this Pae ti 900.00
5. Total of ALL CRO -1430 Pages
$ 3,185.01
(This fine mast be on line 2/ of Detailed Swnmo� Page CR(1-1/0(I) , i
CRO -1430 �, , r, Board of Elections December 2007
Outstanding Loans
\mendmenl
P9 3 of a ❑ Yes ® N,-
Use
u
Use this form to report any outstanding lomis received during a previous reporting period and until the loan is paid in lull.
1. Committee Full Name and Fund ifapplicable) 2. ID Number
Committee to Elect Rick Bucker FJM29B
3. Lender Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Tiae/Pmtession
d. Comments
Finance Officer
Candidate
Frederick Becker III
6603 Sadler Rd
Waxhaw, NC 28173
e. Start Date (mm/dd/yyyy)
e. Employer's Name/Specific Field
10/15/2015
Town of
Mineral Springs
L End Date (mm/dd/yyyy)
g. Rate
In. Security Pledged
L Original Loan Amount
j. Remaining Loam Balance
0
None
$ 300.00
$ 300.00
IL Full Name of Lending Institution
I. Loan Number
3. Lender Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Titin/Pmression
d. Comments
Finance Officer
Candidate
Frederick Becker III
6603 Sadler Rd
Waxhaw, NC 28173
e. Start Date (mm/dd/yyyy)
a Employer's Name/Specific Field
10/30/2015
Town of
Mineral Springs
L End Date (mm/dd/yyyy)
g. Rate
h. Security Pledged i. Original Loan Amomnt
J. Remaining Loan Balance
0 %n
None S 100.00
$ 100.00
It. Full Name of Lending Institution
L Learn Number
3. Lender Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b..lob Iitte Profession
d. Comments
R1 C E IV ED
OCT 2 3 2013
Union Co. board of Eleclions
e. Start Date (mmddyyyy)
c. Employer's Name/Specific Field
L End Date (mm/dd/)ryyy)
g. Rate
h. Security Pledged
L Original Loan Amount
J. Remaining Loan Balance
IL Full Name of Lending Institution
1. Loaa Number
4. Total only this Pae $ 400.00
5. Total of ALL CRO -1430 Pages $ 3,185.01
(This lime mast he on lune 21 of Detailed SamnmrJ!.
( RO-1.13/) NC State Board of Elections December 2007
Amendment
Debts and Obligations Owed By the Committee Pg I or L3 Yes u No
Use this form to report anv unpaid debts or obligations owed by the committee, to include campaign credit c;ird purchase,.
1, Committee Full Name (and Fund if applicable)
2. ID Number
Cunmtitted In 1 lcel Ric], Becket
1-11 N)B
3. Creditor Information
Add ;_,iLjj&move
a. Full .Name. NI inIing Address & Phoo.
lute. All payments nmdc toss'ard debts shoo dd he Iisled on to]
cin, state, & zip)
1310 with
the payee listed as this creditor.
to Description of Creditor
Capital One, PO Box 71087, Charlotte, NC 28272-1087
Capital One Mastercard
c. Beeinning Balance
d. Total Amount Paid
e. Total Amount Incurred
Remaining Balaace
$ 0.00
$
0.00
$
54.60
IL
$ 54,00
. Incurred Debts (what the committee received this period)
1. Purchase Place Full Name, Mailing Address & Phone
g2. Date (mm/dd/yyyy)
g3. Amount
(include city, state, & zip)
10/9/2019
$ �1.nU
g4. Purpose Code
Required Remarks
Staples - online (staples.com), 800-333-3330
A
Paper, Cardstock, Pens
1. Purchase Place Full Name, Mailing Address & Phone
g2. Date (mm/dd/yyyy)
g3. Amount
(include city, state, & zip)
g4. Purpose Code
g5. Required Remarks
A
I. Purchase Place Full Name, Mailing Address & Phone
g2. Date (mm/dd/yyyy)
lg3. Amount
(include city, state, & zip)
g4. Purpose Code j
g5. Required Remarks
1. Purchase Place Full Name, Mailing Address & Phone
g2. Date (mm/dd/yyyy)
g3. Amount
(include city, state, & zip)
$
g4. Purpose Code
g5. Required Remarks
1. Purchase Place nM 1ALAIdIM Phone
g2. Date (mm/dd/yyy y I
g3. Amount
(include city, stat!, & zipl''J
{ 2 3 2019
_ .
g4. Purpose Cate
Remark,
tRequired
4. Total only this Page
(I'his should be the sum of all items 'g3.' from this page)
54.60
5, Total of ALL CRO -1610 Pages
$
(This line must be on line 22 of Detailed Summary Page
CRO -1100)
54.60
6. Pupose Codes List detailed expenditure code in 4.
A* - Media n* - Printing C* - Fundraising
D - To Anuthci Cmididatc
E - Salaries F* - Equipment G
- Political Party
H* - Holding Public Office Expenses
I - Postage J - Penalties K* - Office Expenses
O* - Other
* Codes require detailed explanation in requi remarks field
CRO -]610 NC State Board of Elections February 2011