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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