Hall, Jason_2021-35DayReport -notesDiselosure Report Cover I Amendment
E]mees V 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
. Committee Informs
a. Full Name
e. ID Number
}44)_L 4 W AW-NOA/ (JAs'-A M e Loy ++-4u
6. Type of Committee (Check One)
b. flailing Address (include City, State and Zip Code)
d. Date Filed
toe wq�ctt-�rw PAA14wA`J, v j r
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e. Phone Number
766/ .S7 97
2. Report Year 3. Period Start Date Imm/ddhy)
4. Period End Date Treasurer Full Name
(m mlddh�
6. Type of Committee (Check One)
9. Type of Report check
State/County
Referendum
Candidate Campaign ❑ Party
Municipal
❑ PAC ❑ Referendum
❑ Organizational
❑ Organizational
❑ Organizational
Independent Joint Fundraiser
❑ Expenditure E] Joint
Thirty -rive five da
5' Y'
Quarterly
❑ Pre -referendum
❑ I.egal Expense Fund
7. Type
❑ Pre-primary
❑ First
❑ Final
❑ "Booster Fund"
❑ Pre-election
❑ Second
❑ Supplemental Final
❑ Building Fund
❑ Pre -runoff
❑ Third
❑ Annual
Semi-annual
❑ Fourth
❑ Special
❑ Mid Year
Semi-annual
❑ Other:
❑ Year End
❑ Mid Year
. S Bial Report Name
❑ Final
❑ Special
❑ Year End
❑ Final
8. Number of Fundraisers this Re
❑ Special
11. Account Information
unt Information
a. Financial institution Full Name
a. Financial Institution Full Name
Aw
r50:w<
b. Purpose
c. Account Code
h. Pur se
c. Aecount Code
4WX U1/O/
CA IPAIGN FINANCE
HWX U�.&1
d. Ped Begin lance
d. Period BBalance
CrD 2 p �U��
$�4
f�
CERTIFICATION
I certify that the Committee or Fund is in compliance with all applicaMe
provisions of Article 22A 2213, & 22D -22M of Chapter 163 of
the NC General Statutes and that no funds are commingled with pro
ib ted or her no disclos funds.
I further certify that this report
is complete, true and correct and that I have been trained by the N St a do S.
l\lf6J, F. L_ 1 SEWSK /
iA
spa/
Printed Name of Signer ignatur d of med Treasurer
ffate
FOR OFFICE USE ONLY
Date Received: Employee:
Delivery Method
❑ Normal Mail
Date Postmarked: Employee:
Registered Mail
Hand Delivered
Date Scanned: Employee:
Electronically Filed
❑ Signer has not received
Date Data Entered: Employee:
mandatory 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 -2100A -F) to make committee changes,
CRO -1000 NC State Board of Elections
August 2008
Amendment
Detailed Summary ❑ Yes 1 No
Use this l01Tn to summarize all disclosure reporting forms and to total monetary information.
1. Committee Full Name and Fund if applicable) IWTypeofReport
3. ID Number
,+A,L4- 4 war L:J�$6Al May >
/Total
Start of Election Cycle: January 1,
this
ReportinZ Period
Total this
Election C cle
4)
5)
6)
7)
8)
9)
10)
11)
Cash on Hand at Start
Aggregated Contributions from Individuals
Contributions from Individuals
Contributions from Political Party Committees
Contributions from Other Political Committees
Loan Proceeds
Refunds/Reimbursements To the Committee
Other Receipt Sources
Ila) Interest on Bank Accounts
11b) Contributions from Not -for -Profit Organizations
Ile) Outside Sources of Income
1 l d) Legal Expense Fund — Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRD -1265)
$CN.
00$
Q ,
$ 0,00 $
$,
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
i
13)
14)
15)
16)
17)
"TOTAL RECEIPTS (Add lines 5.6. 7.8, 9. 10, Ila, llb. 11c. Ildand Ile)
Disbursements
13a) Operating Expenditures (CRO -1310)
13b) Contrihutions 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 (CRO -1510)
$
3 ,1610$
1p Q
''tt
$ �s, f7V $
$ $
$ $
$ $
$ $
$ $
$ 3 Q
9
18)
TOTAL EXPENDITURES (Add lines 13a, 13h. 13c, hl. 15, 16 and 17)
$
—11
19)
20)
21)
22)
23)
24)
25)
26)
27)
28)
Cas h o n I la it d at E nd (Add lines 4 and 12 together, then subtract line 18)
Non -Monetary Gifts Given to Other Committees (CRO -1330)
Outstanding Loans (inel. ones from other campaigns) (CRO -1430)
Debts and Obligations owed By the CQIE (CRO -1610)
Debts and Obligations owed9,,tWrV&l4ia (CRO -1620)
Account Transfers Within the Cemmi(leg 2021 (CRO -1720)
Administrative Support EIVED (CRO -1710)
Forgiven Loans (CRO -1440)
48 -Hour Notice Reports Sum (CRO -2220)
Contributions to be Refunded (CRO -1215)
$
, V O
$
$
$
$
$
$
$ $
$ $
$ $
$ $
CRO -1100 NC State Hoard of Elections August 2008
Contributions from Individuals Pg ' of ' Amendment
❑Yes
Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used
1. Committee Fall Name (and Fund if a cable) :. ID Number
4A -Ll -.4 W*v-4- Icw _TlkSa, ►'°te L,o
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, &zip)�
b. Job Title/Profession
d. Comments
!T ��T�✓�
�N McCuy ��
W rf �� L ��i /� YrT►
7
t. Employer's Name/Specific Field
� w D
� 6A�[
no, 51/151
e. Election Sum to Date
$ /03 . ak
f. Prior
g. Account Code
It. Form of Payment
i. In -Kind Description
j. Date (mm/ddlyyyy)
k. Amount
❑
F�NX hl.B'1
CJ�Stf
OY ��1
$ '��7. d3
❑
xw l
cA
d9 Y7
H�7. 0
$
❑
3. Contributor Information ❑ Add ❑ Remove
it. I till Name, hailing .Address & Phouc
(include city, state, & zip)
b..lob Title/lhvfession
d. Comments
c. Employer's Name/Specific Field
e. Election Sum to Date
G Prior
g. Account Code
It. Form of Payment
i. In -Kind Description
j. Date (mmldd/yyyy)
k. Amount
❑
$
❑
-1:1-7-
$
TS
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
UN10c p NPaG,-
c. Employer's Name/Specific Field
e. Election Sum to Date
f. Prior
g. Account Code
h. For t
i. In -Kind Description
j. Date (mm/dd/yyyy)
k. Amount
❑
$
❑
$
❑
$
4. Total only this Page hY $ , D
5. Total of ALL CRO -1210 Pages
{This line ntust be online b of Dilailed Summary Page CRO -1100) 1 r
CRO -120 NC Slate Board ol'Llectiuns April ?ixi?
Amendment {�
Disbursements Pg ' of / ❑ Ves ♦u
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
committees and coordinated party expenditures.
1. Committ aine'atr ' uAahtcabl 3. ID Number
W ASC T
3. T--
Ype of Disbnrsement Please se se state CRa1310 orins for each type of Disbu . end
()perawig I.Npcll>c, ❑ offliihmions to Candidutc, I"'liu..11 ( ;3innlittL�c, ❑ Coordin.(tcd Parti I \henkliiure,
4. Payee Information Add Remove
a. Full Name, Mailing Address & Phone
include city, stale, & zip)
b. Coordinated Committee Name
d. Comments
r{ i�
N�7:3 S
c. Level Registered (Specify)
❑ Federal County:
❑ State Municipality:
e. Election Sum to Date
$
f. Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
t+WXWAYl
CA$*
a
o8 f tr ,,� �
� ��.ov
�K Fef eYM"
{ vXN�6t
C�5l�"
Oq 13'.1621
$ 11.d0
01
F -we -f f S
Information ❑
Add El Remove
d. Comments
A. Full Name. Nlailin--'kddr,,s & Phone
include cit% . ,tate, & zip)
h. Cunrdinated f ouunittee .\note
c. Leel Registered (Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality:
e. Election Sum to Date
f. Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
$
4. Payee Information AM&
Add
b. Coordinated Committee Name
d. Comments
a. Full Name, %tailing Address & Phone
include city, state, & zip)
�tlo CE
G��pP�" Ori{
G` L1
C. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality:
e. Election Sum to Date
$
f. Account CodForm of Payyment ode
i. Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
.,!al only this Pae 5 Q
`.1 of ALL CRO -1310 Pages
(Tkis linegoes in line 13a of Detailed Sumnwry Page CRO -1100 if Operating Erpeorses)
(This line goes in line lab of Detailed Summar)' Page CRO -1100 if Contrib to CandidateslPolilical Comm)
(This line goes in litre 13c of Detailed Summon• Page CRO -1100 if Cnnrdinated Parr), F. penrtitures)
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 Parte 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)
CR NC State Board of Flections December 2009
In -Kind Contributions Pg 1 of Amendment
1 ❑ yes X .No
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.
1Name (and Fund it a 1
0 1 -4 VAI )(MV 2W6N I%A(2r-1-'Cy"%A"U-)
3. Contributor Information Add 1EEJ1Remove
a. Full Name. Mailing .Address & Phone
(include city, state. & zip)
b. Type of Contributor
c. Comments
Individual
Candi9 date
Party
❑ PAC
❑ Referendum
❑ Other Receipt Source
�vA- 4 A✓TA-J�
0 JI ru�y/A�_- _U4Vj�F_
W ftOA-6C -7
i N d-3 I
d. Election Sum to Date
$ �l
e. Description
E Datemm/dd/
( yriY)
g• Fair Market Amount
C�sya� CtiPMcnl 16NS
o8 acal
$ AL 7e°3
04AMID"J ftA bAJ 516N5
$ 467, a3
$
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Type of Contributor
c. Comments
❑ Individual
❑ Candidate
❑ Party
PAC
❑ Referendum
❑ Other Receipt Source
d. Election Sum to Date
$
e. Description
E Date (mm/dd/ yyri)
g. Fair Market Amount
$
$
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
It. Type of Contributor
c. Comments
Individual
❑ Candidate
❑ Party
PAC
❑ Referendum
❑ Other Receipt Source
l,)
GAMPAiGN FINAN
SEP 2 8 2021
RECEIVED
d. Election Sum to Date
$
C. Description
f. Datemm/d
( d/yyyy)
g. Fair Market Amount
4. Total only this Pa e $
5. Total of ALL CRO -1510 Pa
(This line must be on tine 17 of Delailed Summan Page CRO -1100) $
CRO -1510 NC State Board of Elections December 2007