Becker, Rick_2021-Pre-ElectionReportAmendment
Disclosure Report Cover I ❑ Yes ® Na
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 Bucker
FIM29B
It. Maftg Address (include City, State and Zip Code)
d. Date Filed
6603 Sadler Rd
Waxhaw, NC 28173
10/20/2021
e. Phone Number
(704) 843-5870
2. Report Year
3. Period Start Date (mm/dd/yy)
4. Period End Date
5, Treasurer Full Name
mm(ddJv
2021
09/22/2021
10 Is 1021 Frederick Becker III
6. of Committee Check One)
9. Type
of Report check only one lype of re
rt om one category)
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
❑
Organizational
❑ Organizational
❑ Organizational
Independent ❑
Expenditure ise❑ Joint Fundrar
❑
Thirty-five day
Quarterly
E]Pre-referendum
Legal Expense Fund
❑
®
Pre-primary
Pre-election
❑ First
❑ Second
❑ Final
❑ Supplemencd liu.J
7. Tyne 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 Year10.
Special Report Name
❑
❑
Final
Special
❑ Year End
❑ Final
❑ Special
S. Number of Fundraisers this Report
n
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.
c. Account Code
General
Campaign
1
OCT 2 0 2021
d. Period Begin Balance
d. Period Begin Balance
Account
RECEIVED
$ 136.94
$
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
Frederick Becker III
by the NC State Board -O Elecyy'ggns.
10/20/2021
Printed Name of Signer
Signature of Appointed Treasurer
Date
FOR OFFICE USE ONLY
Date Received:
Employee:Delivery
Method
ElNormal Mail
Date Postmarked:
Employee:
El Registered Mail
® Hand Delivered
Date Scanned: /
Employee:
❑ 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 ❑ Yes ® 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
Committee to Elect Rick Becker
Pre -Election
FJM29B
Start of Election Cycle: January 1, 2020
Total this
Reporting Period
Total this
Election Cycle
4) Cash on Band at Start
RECElMi
5 %ggregated Contributions from Individuals (CRO -1205)
6) Contributions from Individuals (CRO -1210)
7) Contributions from Political Party Committees (CRO -1220)
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
lla) Interest on Bank Accounts (CRO -1250)
11b) Contributions from Not -for -Profit Organizations (CRO -1250)
Ile) Outside Sources of Income (CRO -1250)
lld) Legal Expense Fund — Other Sources (CRO -1270)
11 e) Exempt Purchase Price Sales (CRO -1265)
$
$
136.94
100.00
$
$
141.94
100.00
$ 750.00 $
750.00
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
12)
TOTAL RECEIPTS (Add lines -5,6,7,8,9, 10, Ila, 716, Ile, lld and Ile)
$
850.00
$
850.00
13)
14)
15)
16)
17)
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 (Cao -1510)
$
763.61
$
768.61
$ $
$ $
$ $
$ $
$ $
$ $
18)
TOTAL EXPENDITURES (Add lines 13a, 13b, 13q 14, 15, 16 and 17)
$
763.61
$
768.61
19)
20)
21)
22)
23)
24)
25)
26)
27)
28)
Cash on Band at End (Add lines 4 and 12 logether, then subtract line 18)
ONAI;
Non-.Monelar.i Gifts Given to Other Committees (CRO -1330)
Outstanding Loans (incl. ones from other campaigns) (CRO -1430)
Debts and Obligations owed By the Committee (CRO -1610)
Debts and Obligations owed To the Committee 0)
UNION C�'dPf�_
Account Transfers Within the Committee CAMPAIGN rdW
Administrative Support OCT 2 01CM2 t0)
Forgiven Loans CR0' 0
48 -Hour Notice Reports Sum R E C ��F22
Contributions to be Refunded (CRO -1215)
$
$
223.33
$
223.33
$ 3185.01
$
$
$
_
"" '
$ $
$ $
$ $
$ $
CRO -1100 NC State Board of Eleaions August 2008
Amendment
Aggregated Contributions from Individuals Pate I of 1 ❑ Yes ® No
Optional form used to report NC Contributions From Individuals of $50 or less
1. Committee Fall Name (and Fund if applicable) 2. ID Number
C•ummitlec to F.Iccl Rick Beckci I'JM2OB
3. Contributor Information
u. Amend
6. Account
Code
c. Form of Payment
d. to -Kind
Description
a Dale
mm/d(/
E Amount
1
Cash
10/06/2021
$ 50.00
1
Cash
10/06/2021
$ 50.00
V
$
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
U_
Add
$
Remove
Add
$
Remove
F1 I Add
$
Remove
Add
$
Remove
❑ Add
$
Remove
❑ Add
$
❑ Remove
Add
$
EjRemove
Add
UNION COUNTY
$
Remove
Add
CAMPAIGN FINANCE
$
Remove
❑ Add
OCT 20 2021$
Remove
Add
RECEIVED
$
Remove
Add
$
ElRemove
4. Total only this Page $ 100.00
5. Total of ALL CRO -1205 Pages $ 100.00
(This Ane must be online 5 of Detailed Summary Page CRO -1100)
CRO -1205 NC State Board of Elections April 2007
Amendment
Contributions from Individuals Pg I of I ❑ Yes ® No
Use this form to report indiN idual contributions over $50 or contributions under $50 if form CRO 1205 is not used
I. Committee Full Name (and Fund ifs licable)2. In Number
Committee io Flect Rick Becker FJM29B
3. Contributor Information ❑ Add ❑ Remove
a. Pull .same, %failing Address & Phone
(include city, state, & zip(
b. Job Tide/Profession
d. Comments
Municipal
Finance Officer
(Candidate)
Frederick Becker III
6603 Sadler Rd
Waxhaw, NC 28173
c. Employer's Name/Specific Field
Town of Mineral Springs
Municipal Government
e. Election Sum to Date
$ 750.00
L Prior
g. Account Code
It. Form of Payment
I. In -Kind Description
J. Date (mm/dd/yyyy)
L Amount
❑
I
Ck #4392
10/06/2021
$ 750.00
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job fine/Profession
d. Comments
c Employer's Name/Specific Field
e. Election Sum to Date
L Prior
g. Account Code
It. Form of Payment
L In -Kind Description
J. Date (mm/dd/yyyy)
L Amount
❑
$
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
UNION COUNTY
CAMPAIGN FINANL
OCTlrr2 Q 2021
c• Employer's Name/Specific Field
e. Election Sum to Date
L Prior
g. Account Code
d Form of Paymenttin-Kind
Description
J. Date (mm/dd/yyyy)
L Amount
❑
$
❑
$
❑
$
4. Totals
only this Page $ 750.00
5. Total of ALL CRO -1210 Pages $ 750.00
(This line must be on line 6 of Demiled Summary Page CRU -1100)
CRO -1210 NC State Board of Flections April 2007
Amendment
Disbursements Pit 1 of 1 ❑ Yes No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
committees and coordinated partvexpenditures
Committee Full Name and Fund if applicable) 2. ID Number
Qllniltlllel' to Elect Rick Becker FJM29B
3. Type of Disbursement Please use se arateCRO-1310 orms for each type o D' rsement.
® Operanne I pcnnes ❑ Comrihutwnn to (Candidates' Political ( omminees ❑ Coordinated Puna I xpendiurrc,v
4. Payee Information Add El Remove
a. Full Name, Mailing Address & Phone
include city, slat & a
b. Coordinated Committee Name
d. Comments
USPS
5912 Waxhaw Hwy
Mineral Springs, NC 28108
(704) 843-3713
c. t.e rel Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Stan to Date
$ 661.20
L Account Code
g. Form of Payment
It. Purpose Code
1. Dale (mm/ddlyyyy)
j. Amount
k Required Remarks
1
Ck #102
1
10/08/2021
$661.20
Postage for
Flyers
4. Payim Ltfofmation El Add Remove
a. Full Name, Mailing Address & Phone
include city, stat & zip)
It. Coordinated Committee Name
d. Comments
Office Max
1030 W Roosevelt Blvd
Monroe, NC 28112
(704) 226-9977
c. L. el Registered (Specify)
❑ Federal ❑ County:
❑ state ® Municipality:
e. Election Sum to Date
$ 102.41
E Account Code
g. Form of Payment
It. Purpose Code
L Date (mm/dd/yyyy)
j. Amount
k Required Remarks
1
Ck#101
A
10/07/2021
$102.41
Printing
Flyers
4. Payee Information rl Add El Remove
a. Full Name, Mailing Address & Phone
include city, state, & a
CAMPAIGN FINANCE
21
OCT1. I L I
0 20
RECEIVED
b. Coordinated Committee Name
d. Comments
clxvdRegistered (Sperify)
E] Federal E] County;
❑ State ❑ Municipality:
e. Election Sum to Date
$
L Account Code
g. Form of Payment
It. Purpose Code
L tate (mm/dd/yyyy)
j. Amount
k Required Remarks
$
5. Total only this Page $ 763.61
6. Total of ALL CRO -1310 Pages
(This line goes in line l3a of Detailed Suntan, Page ( RO-1100 if Operating Expenses) $ 763.61
(This fine goes in line 13b of Detailed Summary Page CRO -1100 if Comrib to C'andidates/Powiral Comm)
(This line goes in line 13c of Detailed Summa y Page CRO -1100 if Coordinated Party E'xpend'itures)
7. Purpose Codes st detailed enlenditure code in h. 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 - Penalties K* - Office Expenses O* - Other
* Codes require detailed explanation in required remarks field
CRO -1310 NC State Board of Elections April 2007
Outstanding Loans
Amendment
Pg 1 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 FOR Name and Fund if applicable)
z. 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
Woodworker
Candidate
Frederick Becker III
6603 Sadler Rd
Waxhaw, NC 28173
a Start Date (mm/ddlyyyy)
c. Employer's Name/SpeciBc Field
04/07/2000
Self
L End Date (mm/dd/yyyy)
g. Rate
h. Security Pledged i. Original Loan Amount
J. Remaining Loan Balance
0 %n
None $ 1,380.01
$ 1,380.01
k. Fug Name of Lending Institution
1. Loan Number
3. Lender Information ❑ Add ❑ Remove
a. Full Name. Mailing Address & Phone
(include city, stare. & zip)
b. Job fine/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)
g. Rate
h. Security Pledged TL
Original Loan Amount
j. Remaining Loan Balance
0 %
None
$ 500.00
$ 500.00
k. Full Name of Lending Institution
L Loan Number
3. Lender Information ❑ Add LX 19MG
a. Full Name, Mailing Address & Phone
(include city, stare, & zip)
b. Job 'I itle rales5ion
d. Comments
Finance Officer
Candidate
Frederick Becker III
6603 Sadler Rd UNION COUNTY
Waxhaw,NC 281737AMPAIGN FINANCE
OCT 2 0 2021
E1VED
e. Start Dam (mm/dd/yyyy)
a Employer's Name/Specific Field
2/28/2013
Town of
Mineral Springs
L End Dam (mm/dd/yyyy)
g. Ram
It. Security Pledged
L Original Loan Amount
j. Remaining Loan Balsam
0 %n
None
$ 5.00
_
$ 5.00
IL Full Name of Lending Institution
1. Loss Number
4. Total only this Pae $ 1,885.01
5. Total of ALL CRO -1430 Pages
$ 3,185.01
(This One musi be on line 21 of Detailed .tiummun• Page CRO•I /I)p)
CRO -1430 ,, 1. r.i; December 2007
Outstanding Loans
\mrndnu-m
nr 3 ❑ A , �
Use this Ibnn to report any outstanding loans received during a prcvious rcportin_ Itcriud and until thc linen is paid in lull.
1. Committee Fall Name and Fund if applicable) 2. ID Number
Committee to Elect Rick Becker FJ A4_'113
3. Lender Information ❑ Add Remove
a. Full Name, Mailing Address & Phone
(include city, state, & rip)
b. Job Title/Profession
d. Comments
Finance Officer
Candidate
Frederick Becker III
6603 Sadler Rd
Waxhaw, NC 28173
a Start (late (aua/dd/yyyy)
e Employer's Name/Specific Field
09/27/2013
Town of
Mineral Springs
L End Date (mm/dd/yyyy)
g. Rate
h. Security Pledged
L Original Loan Amount
J. Remaining Loan Balsam
0 %
None
$ 200.00
$ 200.00
k. Fug Name of Lending Institution
L Loss Number
3. Lender Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & rip)
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
10/25/2013
Town of
Mineral Springs
L End Date (mu lyyyy)
g. Rate
It. Security Pledged L Origin-, Loan Amount
J. Remaining Loan Balance
0 %
None $ 200.00
$ 200.00
L Full Name of Lending Institution
L Loan Number
3. Leader Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Tine/Profession
d. Comments
Finance Officer
Candidate
Y
Frederick Becker III
6603 Sadler Rd UNION COUNT
Waxhaw, INC 28173 CAMPAIGN FINA
OCT 2 0 202
RECEIV
e. Start Date(mm/dd/yyyy)
mployw'sName/SpecificField
07/14/2015
Town of
Mineral Springs
D
L End Date (mm/dd/yyyy)
g. Rate
h. Security Pledged
L Original Loan Amount
J. Remaining Loan Balance
0 %
None
$ 500.00
$ 500.00
k. Full Name of Lending Institution
1. Loan Number
E4.t�hs Pae S 900.00
CRO -1430 Pages on line 21 of Detailed Summar• Page CRO -1100) `� 3,1$5.01
CRO -1430 M Stare Board of Eleciiuns December 2007
Outstanding Loans
Amendment
Pg 3 of 3 ❑ Yes ® No
Use this form to report any outstanding Duna received during :i previous reporting period and until the loan is paid in full.
1. Committee Full Name and Fund if a licable)2.10 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
a Start Date (mm/dd/yyyy)
a Employer's Name/Specific Field
10/15/2015
Town of
Mineral Springs
f. End Date (mm/dd/yyyy)
g. Rate IL SecurityPledged
L Original Loan Amount
j. Remaining Loan Balance
0 9J None
$ 300.00
$ 300.00
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 Title/Profession
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
6 End Date (mm/ddlyyyy)
g. Rate
IL Security Pledged
L Original Loan Amount
J. Remaining tnun Balance
0 %
None
$ 100.00
$ 100.00
Ic Full Name of Lending Institution
L Loan Number
3. Lender Information ❑ Add ❑ Remove
H. Full Name, Hailing Address & Phone
(include city, stale, & zip)
b. Job TitleProfesdon
d. Comments
UNION COUNTY
CAMPAIGN FINANCE
OCT 2 0 2021
e. Start Date (mm/dd/yyyy)
c. Employer's Name/Specific Field
r. End Date (mm/eld/yyyy)
g. Rate
edg L Original Loan Amount
J. Remaining Loan Balance
IL Fug Name of Lending Institution
1. Loan Number
4. Total only this Pae
$ 400,00
5. Total of ALL CRO -1430 Pages
(This fine must be on fine 21 of Detailed Summary Page CRO -1100)
$ 3,185.01
CRO -1430 N(',SImc �A PlodIons December 2007