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Elam,Edwin_2021-Org-reportDisclosure Report Cover p vae°` E3Na 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 Name c. ID Number RJM3 I �w,N m �'�(� Com Camr�,ssroJe2 . Mailing Address (include City, State and Zip Code) d. Date Filed /o(, W A,4),,j /2-3 1? u6 2azpl "J 0, / C e. Phone Number � n 7-5-,- 2.Report Year 3. period date u®! 4. Period End Date mm/dd/yy 5. Treasurer Full Nam 12/16 12CZ1 of Committie (Chefck One 9. Type of Report (check only one type of re orf from one category) Candidate Campaign ❑ Perry Municipal e/County Referendum ❑ PAC ❑ Referendum ❑ Organizational Organizational ❑ Organizational ❑ independent Expenditure ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ Pre-primary ❑ Fust ❑ Final ❑ Pre-election ❑ Pre -runoff ❑ Second ❑ Third ❑ Supplemental Final ❑ Annual 7. Type of Fund (if applicable, check one) ❑ Booster Fund Semi-annual ❑ Founh ❑ Special ❑ Building Fund ❑ Mid Year Semi-annual ❑ Year End ❑ Mid Year 10. Special Report Name ❑ Other: ❑ Final ❑ Special ❑ Year End ❑ Final ❑ Special 8. Number of Fundraisers this Report 11. Account Information 11. Account Information . Financial Institution Full Nam//�� a. Financial tastitution Full Name IRS'( NPrTIONAL &NK . Purpose a Account Code b. NCE c. Account Code OEC 16 2021 Period Begin Balance d. Period Begin Balance 6tt�+ o.tnd. $� s EIVED 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, we and correct and that I have been trained b the NC State Board of Elections. V/�, 0_V ✓(,ov[2 ii VSA 12/16 /2022 Printed Name of Signer Signal= of Appointed Treasurer Date FOR OFFICE USE ONLY Date Received: Employee: Delivery Method ❑ Normal Mail Date Postmarked: Employee: Registered Mail Hand Delivered Date Scanned: Employee: Electronically Filed Date Data Entered: Employee: r3 Signer has not received mandato training 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-210OA-E) to make committee changes. CRO -IOW NC State Board of Elections August 2008 Detailed Summar Amendment Y ❑ Yes ❑ No Use this form to summarize all disclosure renortin¢ forms and to total monetary information 1. Committee Full Name (and Fund if applicable) 12. Type of Report . ID Number Arvin Ela', 6W49 C0&MnUS%iC'tRX I ATM 320 - Start of Election Cycle: January 1, 2019 Total this Reporting Period Total this Election Cycle 4) Cash on Hand at Start $ $ RECEIPTS 5) Aggregated Contributions from Individuals 6) Contributions from Individuals 7) Contributions from Political Party Committees 8) Contributions from Other Political Committees 9) Loan Proceeds 10) Refunds/Reimbursements to the Committee 11) Other Receipt Sources 1In) Interest on Bank Accounts 11b) Contributions from Not -For -Profit Organizations IIc) Outside Sources of Income l ld) Legal Expense Fund -Other Sources Ile) Exempt Purchase Price Sales (CRO -1205) (CRO -1110) (CRO -1120) (CRO -1230) (CRO -1410) (CRO -1240) (CRO.1250) (CRO -1250) (CRO -1250) (CRO -1270) (CRO -1265) $ $ $ f $ g} $ $ $ $ $ $ $ $ $ $ $ S $ S $ ti $ $ 12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10,11a,1 Ib,11c,I Id and l le $ S EXPENDITURES 13) Disbursements 13a) Operating Expenditures 13b) Contributions to Candidates/Political Committees 13c) Coordinated Party Expenditures 14) Aggregated Non -Media Expenditures 15) Loan Repayments 16) Refunds/Reimbursements from the Committee 17) In -Kind Contributions (CRO -1310) (CRO -1310) (CRO -1310) (CRO -1315) (CRO -1420) (CRO -1320) (CRO -1510) $ $ $ S $ $ $ $ $ $ $ S $ 4- $ $ 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ FS $ 8 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18 $! ADDITIONAL INFORMATION 0) Non -Monetary Gifts Given to Other Committees 1) Outstanding Loans (incl. ones from other campaigns) 2) Debts and Obligations owed by the Committee 23) Debts and Obligations owed to tl)q.Cpmmiiteq . •, 4) Account Transfers Within the Cdnntl t%'e 5) Administrative Support 26) Forgiven Loans�{ 7) 48 -Hour Notice Reports Sum " ' `— " ,I (CRO -1330) (CRO -1430) (CRO -1610) (CRO -1620) (CRO.1720) (CRO -1110) (CRO -1440) (CRO -2220) $ $ $ $ $ AN $ $ $ $ $ $ Contributions to be Refunded (CRO -1215) $ $ NC State Board of Elections August 2008 \mcndmeuf Contributions from Individuals Pg1 of I ❑ , ❑ No Use this formto report iudividu:d contributions over S`O nr amtributionv under SS() it linin CRO I 10 is not used 1. Committee Full Name (and Fund if applicable) 2. ID Number 3. Contributor Information ❑ Add ❑ Remove it. Gull Name, Mailing Address & Phone (include city, state, & zip) 2:D W t (R it,�n1 yb sl / ov la A -,c h a,w PA,2 k w aF / 13 /f C z,&(7 3 b. job Title/Profession it. Contents c. Employer's Name/Specific Field .Emp /� / 1 aS� rn c� "37-cl e. Election Sum -Ito Dale f Prior g. Account Code 11 h. Form of Pecntent i. �In-Kind Description J. Date (mmlddlyyyy). k Amount ❑ $ ❑ ti 3. Contributor Information ❑ Add ❑ Remove it. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession It. Contents c. Employer's Name/Specific Field e. Election Sum to Date $ 1. Prior ❑ g. Account Code h. Form of Payment i.In-Kind Description J. Date (mm/dd/yyyy) It. Amount $ ❑ $ ❑ $ 3, Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, &-zip)., b. Job Title/Profession d. Comments DEC 16 2021 RECEIVED c. Employer's Name/Specific Field e. Election tiunt to Dnte $ .Prior ❑ g. Account Code h. Form of Payment I. In -Kind Description J. Date (nan dd/yyyy) k Amount $ ❑ $ 4. Total only this Page $ 972-0 5. Total of ALL CRO -1210 Pages $ 7 (This line must be ars line G oj'Detailed Summary Page CRO -11011) l CRO -1210 NC Cwic board ofElccGon, April 2007 \mendmm�t In -Kind Contributions Pgae l ❑ ❑ Nn Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund. Use CRO -1215 if In -Kind Contributions were or will be refunded within 7 days. 1. Committee Full Name (anti Fund if applicable) 2. ID Number 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone IT), a of Contributor c. Comments (include city, state, & zip) ®Kdividral Ea Candidate ❑ Party goo w ��kway f23 13 PAt Referendum d. Election Sum m Date 1 i/)aX _. , , 1 OC 28 /1..J5 Other Receipt Source [3f. $ ST e. Description Date (mm/dd/yyyy) g. Fav Market Amount 1�061�2-t $ 3. Contributor Information ❑ Add ❑ Ramoae a. Full Name, Mailing Address & Phone b.1 pe of Contributor c. Comments (include city, state, &zip) ❑ li idi, ideal ❑ Candidate ❑ Party ❑ PAC ❑ Referendum d. Election Sum to Date ❑ Other Receipt Source S r. Description E Date (mnridd/yyyy) g. Fair Martie( Amount $ $ 3. Contributor Information ❑Add ❑ Remove a. Full Name, Mailing Address & Phone h. Tope at Contributor c. Comments limdmle cite -, 'rate, & zip) .. ;�-r,`� ;..--- ---__ -- ❑ Candidatedual �1 ULt. b Z0qq(.11 I ❑ Party ❑ PAC R E C E I V E D ❑ Referendum ❑ Other Receipt Source it. Election Sum if, Dale $ e. Description E Date (mm/ddlyyyy) g• Fair Market Amount $ $ $ 4. Total only this Page $ $�, — 5. Total of ALL CRO -1510 Pages $ (This line must be on line 17 of Detailed Summary Page CRO -1100) U �. CRO -1510 NC State Board of Elections December 2007