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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