Elam,Edwin_2021-Year-endDisclosure Report Cover E3 v smeOIM 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.
I: Committee Information'
a. Full Name
c. ID Number
EDWIN ELAM FOR COUNTY COMMISSIONER
A JM320
It. Mailing Address (include City, State and Zip Code)
__
_p
d. Date "led
100 WAXHAW PARKWAY
__
01/27/2022
PO BOX 123
]AN 31 422
WAXHAW, NC 28173
e. Prone Number
Union Co, kwo pl *UM
Z,ReportYear
13. Period Date (mmld(llYY)
4. Periotl+ ( -
. �fiF�iismret
FUR JYatlAe..:m
2021
_Start
12/06/2021
12/31/'_021
VLADISLAV KOVALEVSKY
Type of Committee (Check One)
9. Type of Report (check
only one rvpe ofrepor!
from one eat p�j
® LandILLitC Campaigji ❑ Parn
Municipal
Stale/( ounty
Referendum
❑ Joint Fundraiser ❑PAC
❑
Organizational
❑ (hgantzational
❑ Organizational
❑ Referendum ❑ Legal Expense Food
❑
❑
Thiry -five day
Pre-primary
Quarterly
❑ First
❑ Pre -referendum
❑ Final
T. Type ofFhnd fflg}zplicable dim brief
❑ "Booster Fond" -
❑
Pre-election
❑ Second
❑ Supplemental Final
❑ Building Fund
❑
Pre-rmoff
❑ Third
❑ Annual
❑ Presidential Election Year Candidates Fond
Semi-annual
❑ Fourth
❑ Special
❑ NC Public Campaign Financing Fund
❑
Mid Year
Semi-annual
❑
Year End
❑ Mid Year
10. Special Report Name
13(hher.
❑
❑
Final
Special
® Yew End
❑ Final
.
8. Number of Fundraisers this Report
U
❑ Special
3. Account Information
3. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
I I RST NATIONAL BANK
b. Purpose
c. Account ( ode
b. Purpose
e. Account Code
FOR CAMPAIGN
UCEE22
RELATED ACTIVITY
it. Period Begin Balance
it. Period Begin Balance
S
0.00
CERTIFICATION
I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 22D -22M of
Chapter 163 ofthe NC General Statutes and that no funds are commingled with prohibited or other non -disclosed
funds. I further certify that this report is cornplete,
true and correct and that I have been trained by the NC State Board
:%UIWS(AV KDvALEVSKy
l7 01/27/2022
Printed Name of Signer
Signature of Appointed Treasurer Date
FOR OFFICE US E ONLY
1&*
Date Received:
Deliv ethod
Err�loy
Normal Mail
Date Postmarked:
Employee:[3Registered Mail
r_[3 Hand Delivered
I
. '
Date Scanned: (�
Employee:Jl� ❑ Electronically Filed
f `7�=
Date Data Entered:
Employee: [3 Signer has not received
mandatory training
Please Note: This for i cannot be used to amend committee information such as the committee address, treasurer,
assistant treasurer, custodian
ofbooks information, or account information.
You must arnend the Statement ofOrganization
CRO -2100A -E to make committee changes,
CRO -1000 NC State Board of Elections December 2007
Detailed Summa Amendment
ry ❑ Yes ® No
Use this forinto summarize all disclosure reporting forts and to total monetary information
1. Committee Full Name and Faud ificable
2. of Re
3. ID Number
EDWIN ELAM FOR COUNTY COMMISSIONER
2021 Year End Semi -Annual
A-TM320
"i
Start of Election Cycle: January 1, 205
Re
Total this
rtin Period
Total this
Rection Cycle
4) Cash on Hand at Start
$
0.00
$
0.00
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
0) Refunds)Reimbursementstothe Committee
I) Other Receipt Sources
Ila) Interest on Bank Accounts
lib) Contributions from Not -For -Profit Organizations
I le) Outside Sources of Income
I 1 d) Legal Expense Fund -Other Sources
I le) Fxempt Purchase Price Sales
(CRO -1105)
(CRO -1210)
(CRO -1210)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1150)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
$ 0.00
$
0.00
$ 412.00
$
412.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$ 0.00
$
$
0.00
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
2) TOTAL RECEIPTS (Add lines 5.6. 7. 8, 9,10,11a,I Ib,I Ic,I I and lie)
$
412.00
$
412.00
EXPENDITURES
3) Disbursements
13a) Operating Fxpenditures
13b) Contributions to Candidates/Political Committees
13c) Coordinated Party Expenditures
4) Aggregated Non -Media Expenditures
5) Loan Repayments
6) Refunds/Reimbursements from the Committee
7) In-MtndContributions
(CRO -1310)
(CRO -1310)
(CRO -1310)
(CRO -1315)
(CR04420)
(CRO -1320)
(CRO -1510)
$
275.00
$
275.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 137.00
$
137.00
$) TOTAL EXPFNDITURFS (Add lines 13a. 13b, 13c, 14, 15, 16 and 17)
$
412.00
$
412.00
9) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18)
$
0.00
$
0.00
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees
1) Outstanding loans (incl. ones from other campaigns)
2) Debts and Obligations ovvedby the Committee
3) Debts and Obligations owed to the Committee
4) Account Transfers Within the Committee
5) Administrative Support
6) Forgiven Loans
7) 48 -Hour Notice Reports Sum
(CRO -1330)
(CRO -1430)
(CRO -1610)
(CRO -1620)
(CRO -1710)
(CRO -1710)
(CRO -1440)
(CRO -1110)
--
--•
$ 0.00
$ 0.00
..
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
8) Contributions to be Refunded
(CRO -1115)
$
0.00
$
0.00
CRO -1100 NC State Board of Elections August 2008
Amendment
Contributions from Individuals Pg Of 1 ❑ 1 e ® No
Use this form to report individual contributions over $50 or contributions under $50 iffonn CRO 1205 is not used
f. CbinnWee Mill Iftaii (MdFmd if applicable)
EDWIN ELAM FOR COUNTY COMMISSIONI.R
2.IDNamber
ATIV32o
3. Contributor Information ❑ Add ❑ Rernove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
LIFE INSURANCE AGENT
c. Employer's Name/Specific Feld
SELF-EMPLOYED
d. Comments
e. Election Sum to Date
$ 412.00
EDWIN ELAM
100 WAXHAW PARKWAY
PO BOX 123
WAXHAW, NC 28173
(704) 475-6588
f. Prior
III. Account Code
It. Form of Payment
1. In-IGnd Description
J. Date (mm/ddlyyyy)
k. Amount
❑
UCEE22
In -Kind
FILING FEES
12/06/2021
$ 87.00
10
UCEE22
In -Kind
CAMPAIGN DONATION
TO SWEET UNION
12/09/2021
$ 50.00
❑
UCFF22
Electric Funds Iran
12/10,'2011
$ 275.00
4. Total only this Page
s 412.00
5. Total of ALL CRO -1210 Pages
(Tbis Line must be on &e 6 ojDetaeled Summary Page CRO -1100)
s 412.00
('RO-1210 NC State Boardof lilections April 2007
Amendment I.
Disbursements Pg 1 of 1 ❑ Yes ®No
Use this formto report expenditures fromthe committee for operating expenses, contributions to candidate/political
corrrnittees and coordinated party expenditures
1. Committee Full Name (and Fund if applicable)
2. ID Number
EDWIN ELAM FOR COUNTY COMMISSIONER
4J-lq 320
3. Type of Disbursement (Please aseseoarate CRO -1310 forms for each tune oflNsbarsetnent.)
IN OPerm ire Ls Penses El('om rihuGons lu Cundilhtte.'Pnlit ictal Committees Coordinated Pam Il \PendiliaeS
4. Payee Information
❑ Add ❑ Remove
a. Full Name. Mailing Address & Phone
(include city, state, & zip)
It. Coordinated Committee Name
d.Comments
BRIAN TALBERT
26111 MILLINGPORTRD
ALBERMARLE, NC 28001
c Level Registered (Specify)
Federal County
❑ Aate ❑ Municipality:
C. Election Sum to Date
$ 100.00
f. Account Code
1g. Form of Payment
Ill. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
Is. Required Remarks
UCEE22
Electric Funds Tran
O
12/22/2021
$ 100.00
CHRISTMAS: TWO
S
4. Payee Information
❑ A#il ❑ Remove
a. Full Name, Mailing Address & Phone
include city. state, & zip)
UNION COUNTY BAPTIST MINISTRIES
FELLOWSHIP
PO BOX 897
WINGATE, NC 28174
h. Coordinated Comm i nee yam a
it. (lnn fire n is
c. Level Registered (Specify)
Federal 13 County:
❑ State ❑ Municipality:
e. Flection Sum to Date
$ 175.00
f. .account Code
g. Form of Payment
h. Purpose Code
L Date (mm/dd/yyyy)
j. Amount
1k. Required Remarks
UCEE22
Check
O
12/21/2021
$ 175.00
1 CONTRIBUTION
Is
5. Total only this Page
- .`
$ 275.00
6. Total of ALL CRO -1310 Pages
(This lite ones in line /3a of Detailed Summary Page CRO -1100 if Operating Expenses) $ 275.00
(This line goes in line lab of Detailed Summar' Page CRO -1100 if Contrib to Candidaies/Politiea/ Comm)
(This line goes in line 13c of Delailed.SummarPage CRO -I1 //0 if Coordina(ed Pont' Erpenditvret/
9. Purpose Cotes (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 Public Office Expenses
1 - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* Other
* Codes require detailed explanation in required remarks field(k)
CRO -1310 1,C State Hoard of Elections December 2009
Amendment
In -Kind Contributions Pg of I ❑ les ® Nn
Use this form to report non -monetary contributions, donations, goods or services provided to the committee Lir (Lind.
Use CRO -1215 if In -Kind Contributions were or will be refunded within 7 days.
1. Committee Full Name (and F1md if applicable)
12.ID Number
EDW IN EL.AM FOR COI INTY COMMISSIONER
n � n,1 32 O
r 1 1 J
3. Contributor Information
❑ Add [3 Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip(
EDWIN ELAM —
100 WAXHAW PARKWAY
PO BOX 123
WAXHAW, NC 28173
(704) 475-6588
b.'I)pe of Contributor
Individual
❑ Candidate
❑ Party
❑ PAC
❑ Referendum
❑ Other Receipt Source
c. Comments
d. Flection Sum to Date
5 412.00
e. Description
L Date (mm/dd/yyyy)
g. Fair Market Amount
FILING FEES
12/06/2021
$
87.00
CAMPAIGN DONATION TO SWEET UNION REPUBLICAN WOMEN
12/09/2021
$
50.00
4. Total onhthis Page
5
137.00
5. Total of ALL CRO -1510 Pages
(This line must be on gne 17 ojDerai1ed Summazp Page CR0.7100)
$
137.00
CRO -1510 SC State Board of l lection, December2007