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Bention,Jimmy_2021-Year-endndnant Disclosure Report Cover o yes •LI 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 . Full NameLL c. ID Number Lo ff)rf i.4{t'- G L I,?- (-f Sr- . Mailing Address (include City, State and Zip Code) it. Date Filed 30GL Iuchcr S4ree+ a3/ a M 1� 1a r% Pin e., ^f r— aY I (J e. Phoce Number Toy -S?a Report Year 3. Period Start Date (mmldd yy) 4. Period End Date (mmlaatyy) 5. Tr�r Furl Name aC, I la/01 /aoaj la /if /ao� +� L. c� &Aro . T pe of Committee (Check One) 9. Type of Report (check only one type of report from one category) Candidate Campaign ❑ Party Municipal Statelcounty Refereadmn ❑ PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational ❑ Independent Expenditure ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ Pre-primary ❑ First ❑ Final ❑ Pre-eleetion ❑ Pre -runoff ❑ Second ❑ Third ❑ Supplemental Final ❑ Annual 7. Type of Fund Wapplicable. check one) ❑ Booster Fund Semi-annual ❑ Fourth ❑ Special ❑ Building Fund ❑ Mid Year Semi-annual Rr Year End ❑ Mid Year 10. Special Report Name ❑ Other: ❑ Final 113Special [;3— Year End ❑ Final S. Number of Fundraisers this Report ❑ Special 11. Account Information IL Account Information . Financial Institution Full Name a. Financial Institution Fall Name elis Fo,.r5o h. Purpose c. Account Code b. Purpose c. Account Code le.e+ior, 0 4 Co Mr-) i +f e E d. Period Begin Balance it. Period Begin Balance - -- Do �� ion $ � 30 $ CERTIFICATION 1 certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 2213-22M 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 Elections. ' 01 a3 �2k Lc..4a4 d L. Des.+; on, ��"�J—.�,Y LAppointed Printed Name of Si nor —Signature of A inted Treasurer Date FOR OFFICE USE ONLY r Date Received: Empl c Method ❑ Normal Mail Date Postmarked: Employee: r❑ egistered Mail Hand Delivered Electronically Filed Date Scanned: � � a Employee: �� Dale Data Entered: Employee: ❑ Signer has not received mandato train Please Note: This form cannot he used to amend committee information such as the commi ttIMam"er. assistant treasurer, custodian of books information, or account infotma AMPAIGN FINANCE You must amend the Statement of Organization (CRO -21 00A -E) to make committee changes. CRO -1000 NC State Board of Elections gust 2008 RECEIVED Detailed Summar Amendment Y O Yes [12'N" Use this form to summarize all disclosure reoortine forms and to total monetary information 1. Committee Ful_ Name (and Fund if applicable) Co(n m; ee 4. t lec► Qr&,. 2. Type of Report Sc+•ti - /inn Vali ycar t.4 3. ID Number Start of Election Cycle: January 1, Total this Reporting Period Total this Election Cycle 4) Cash on Hand at Start $ 00 O $ RECEIPTS 5) Aggregated 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 (CR0.1240) 11) Other Receipt Sources Ila) Interest on Bank Accounts (CRO -1250) lib) Contributions from Not -For -Profit Organizations (CRO -1250) Ile) Outside Sources of Income (CRO -1250) l lid) Legal Expense Fund -Other Sources (CRO -1270) Ile) Exempt Purchase Price Sales (CRO -1265) $ $ $ • ../0, C9 Q $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12)TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10,11 a, l l b, I l c, l l d and l Ie) $ '2e2 $ EXPENDITURES 13) Disbursements 13a) Operating Expenditures (CRO -1310) 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) $ J b $ $ $ $ a (o• S $ $ $ $ $ $ $ $ $ 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ $ 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18 $ 8 $ DITIONAL INFORMATION 0) Non -Monetary Gifts Given to Other Committees (CRO -1330) 1) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) 2) Debts and Obligations owed by the Committee (CRO -1610) 3) Debts and Obligations owed to the Committee (CRO -7620) 4) Account Transfers Within the Committee (CRO -1720) 5) Administrative Support (CRO -1710) EForgiven Loans (CRO -1440) 7)) 48 -Hour Notice Reports Sum (CRO -2220) Contributions to be Refunded (CRO -1215) $ $ $ $ $ $ $ $ �A1PAI - $ $ $ $ CRO -1100 NC State Board of Elections RECEI Contributions from Individuals Pg of _ p Yes la Amendment Use this form to report individual contributions oxer $50 or contributions under $50 if form CRO 1205 is not used if applicable) tinualf - Nanid`(tiii d pp — _ CA)n��onsr- 3. Contributor Information ❑ Add ❑ Remove a. Pull Name, Mailing Address & Phone (include city, state, & zip) en i5 C Yn 6 qu/%11- %1j.2o 14a I I ✓lvtrlL GJ- .2 o '? 61-7 3 b. Job Title/Profession d. Comments c. Employer's No Field_ e. Election Sum to Date $ up. D a I. Prior g. Account Code h. Form of Payment I. In -Kind Description j. Date (mmtddtyyyy) k Amount o $ ❑ 3. Contributor Information ❑ .-Wd ❑ Rcn-u� o a. full fume„Ahailing Address & Thune (include city, state, & zip) 3 o 6—y L. �d ,net C, i t,)n yl,at.) fJC� �isl 73 J b..loh 'fine/1'rote"io11 it. 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 (nWddtyyyy) k Amount I OV $1OD. OD ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Pull Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Na�old - XY401 t=lGiS Mafs 5�r-�e}- c. Employer's Name/Speffic Field e. Election Sum to Date f. Prior o - g. Account Code O h. Form of Payment CSS I. In -Kind Description J. Date (mmlddlyyyy) baa k Amount $ - -/-2g ❑ $ ❑ $ 4. Total only this Page S 5. Total of ALL CRO -1210 Pages (This line wust be on line 6 of Detailed Sunmmry Page CRO -1l00) $ CRO -1210 Al' ,,,, is. - .T 1..q I_'ImWh, April 200- Contributions from Individuals Pi 21 of _ Amendment Yn No ce Ihic Inrn, In "ruin indnirlual contributions o,cr S50 or contributions under $50 if foml CRU 1200 is not used 1. Committee Full Name (and Fund if applicable) 2. to Number o o F - e c ✓- 6en 5 3. Contributor Information Add Remove a. Full Namo Nailing Addrev&Phone (include city, state, & zip) b.Job-rdle/Profession d.Commnb I,�'edd i n gin � NG �l04 FJ Employer'sNameSpecincField e. Elnuon sum It Date S EPrior g.Aceoum Code It. Form or Payment ji. In-kind Description '. Due lmmlddlyyyy) ILAmount O JbS0•dZl s s . Contributor Information Add Remove a. Fall Hama, vl.aing ked. &none (inelude city, stale. & zip) It. M riitle/Prol.inn a. Commmm e. Employer's Name,S ecinc Field e. Election Sum to Dale L Prior & Arcounl Code h. Form of Payment IL In-kind Description '. Date Imm/dd/yyyyq ik..%mount S 1 3. Contributor Information Add Remove a. Full Same, Nailing Address & Phone I lnelude cin, slate. & .ipI b. Job Ttle/Profession d.Camments c. Employer's NemeSpeeifir Field e. Election Sum to Date LPrme &Asmunt Code 1h. Form of Payment Ii.In-kind Description '. Date(mm/dd/yyyy) 11LAmount b N 4. Total only this Page $ 5. Total of ALL CRO -1210 Pages 5 (This fine must be on lined J Dmuiled.5'ummay Psee CRO -11") (FO -1214 N( Stale Domd of Llell o', Npril ]011e ICJ'. rl i-'i1l I^.1-�r IAf.i i5'V Disbursements Amendment �/ Pg -1—-I' _K_ 13yesI� Nu Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political committees and coordinated party expenditures Committee Full Name (and Fund if applicable) 2. Number CG(1) 4ems to E 2e v. a oti 5t. m .Type of Disbursement (Please use separate CRO -1310 forms for each Noe of Disbursement.) _ Operating Expenses r,,,r Contributions to Candidates/Political Committees yrrnordinated Party Expenditure, Payee Information ER -Add 0 Remove Full Name, Mailing Address & Phone It. Coordinated Committee Name d. Comments include city, state, & zip) _ Hc—zQ_1'.s CC) ff<< Hose t� 01,j 10 9 Di G 1(t rS es ti c. Level Registered(Specify) Federal C: 13JB'ounty fpp 1 f O t1 r' O4 r A/C. as 1 I ❑ State ❑ Municipality: e. Flection Sum to Date $ . Account Code it. Form of Payment h. Purpose Code L Date (mm/ddlyyyy) J. Amount L Required Remarks I v o De ,+ e- � J 0 1a/06 /aoai $ Z6- S $ 4. Payee Information Add El Renune . Full Name, Mailing Address & Phone It. Coordinated Committee Name d. Comments (include city, state, & zip) c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date It . Account Code g. Form of Payment h. Purpose Code i. Date (mmlddlyyyy) '. Amount k Required Remarks Is I 4. Payee Information ❑ Add ❑ Remove . Full Name. Mailing Address & Phone b. Coordinated Committee Name d. Comments (include city, state, & zip) c. level Registered (Specify) _ ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ L %ccount Code g. Form of Payment h. Purpose Code L Date (mmtdd/yyri) I. Amount h. Regdred Remarks $ $ 5. Total only this Page $ �3-6. S 6. Total of ALL CRO -1310 Pages (This tine goes in line 13a of Detailed .Summary Page CRO -1100 if Operating Expenses) (This line goes in line lab of Derailed .Summary Page CRO -1100 sf Contrib to Candidates/Political Comm) $ - C p O I (This line goes in line lac of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) 7. Purpose Codes (List detailed expenditure code in (h.) above) * - Media B* - Printing C* - Fundraising D- To Another C:mdiJa(e E - Salaries F* - Equipment G - Political Party H* - Holding Public 011 -we lspenws I - Postage J - Penalties K* - Office Expenses Q* - Donition to Legal Expense Fund * Other * Codes reauire detailed explanation in re wired remarks field k CRO -1310 NC State Board of Elections Ucccmh" Jur, Disbursements Amendment Pg _L_of at 13ry Yes t=1 No Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political committees and coordinated part ex nditures Committee Name (a if app cab e) rn . fee . Llec v. 2. Number pe of Disbursement (Please use separate CRO -1310 forms for each type of Disbursement.) emting Expenses ❑ Contributions to CandidatesiPolitical Committees ❑Coordinated Pan Expenditures yee Information Add ❑ Remove l Name, Mailing Address & Phone de city, state, &j zip) 10 -rile- 1 S q 5r S L4 Ca. n+e r � Iia r �{ w w y 5 0. A n } p n; o, TX % F o1 S 1, h. Coordinated Committee Name d. Comments cc. Level Registered (Specify) [ Federal y� County: ❑ State ❑ Municipality: a Election Sam to Date $ . Account Code () g. Form of Payment (jdnl< r It. Purpose Code O i. Date (mm/ddlyyyy) /a,/&/�.ZOs11 . Amount L Required Remarks GaM for ACCOvn+ $8• O U Is 4. Payee Information LrAdd U Remove . Full Name, Mailing Address & Phone (include city, state, & zip) unicl. Cour..}y O U 0. r d Of E. 1 e e.}; un s 3 I U-(5 E 45 } W i n d J o r 5{ r C t+ nonroe, /JC agllI_ b. Coordinated Committee Name d. Comments c. Level Registered (Specify) ❑ Federal ❑`county: ❑ State ❑ Municipality: e. Election Sum to Date 1 $ . Account Code ICY g. Form of Payment Fe6.1 �� I h. Purpose Code O i. Date (m ulddlyyyy) . Amount it. Required Remarks c4li ft Tl t` t� e la/oh/aoAl $42. oo Is 1 4. Payee Information Add Remove . Full Name, Mailing Address & Phone (include city, state. & zip) b. Coordinated Committee Name d. Comments c. Level Registered (Specify) ❑ Fedcral ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ I. Account Code g. Form of Payment 1h. Purpose Code it. Date (mm/dd/yyyy) h. Amount JIL Required Remarks Is is 1 5. Total only this Page $ $ 1, , O 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm) (This line goes in line lac of Detailed Summary Page CRO -1100 if Coordinated Pady Er enditures) $56- v O 7. Purpose Codes (List detailed expenditure code in (h.) above) A* - Media B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding PtiMiife Expenses I - Postage J - Penalties K* - Office Expenses Q* - Donation t0 Lpgl(f xpensc Fund O* Other * Codes renuire detailed explanation in required remarks field it CRO-1310 NC State Board of Elections Itecamhrr _iur I_.