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Hall, Jason_2021-35DayReport-amendmentamendment Disclosure Report Cover teS ❑ No Use this form for _eneral report and committee information, must be signed and submitted along wit formS. Do not use this form to update information 1. a. Full Name c. ID Number H*u,4 i *XtfAW 145clil%) MCC—I q HAU-) b. Mailing Address (include City, State and Zip Code) d. Date Filed 40 GvAxruf11 * y, uiu, T God _ 09 jay aes 1 c. Phone Number 2. Report Year 3. Period Start Date (mm/dd/yy)a• Period End Date 5. Treasurer Full Nam mm/dd �a1 07�o,�aoa/ o9a�/aoa/ DAtvJr� G. of Committee Check 9. T Candidate Campaien ❑ Party Municipal State/County Referendum PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational Independent raiser ❑ El Expenditure Joint Fund Thi five da yex rty'- T Quarterly ❑ Pre -referendum Legal Expense Fund ❑ Pre-primary ❑ First ❑ Final ❑ "Booster Fund" ❑ Preelection ❑ Second ❑ Supplemental Final ❑ Building Fund ❑ Pre -runoff ❑ Third ❑ Annual Semi-annual ❑ Fourth ❑ Spm.J ❑ Mid Year Semi-annual ❑ Other: ❑ Year End ❑ Mid Year e ❑ Final ❑ Year End S. Nu" of F ❑ Special ❑ Final /Vox I— ❑ Special 11. Account Information ecount Information - a. Financial Institution Full .Name a. Financial Institution Full Name b. Purpose c. Account Code b. P CN CO(JNTY c. Account Code c4m AA 4V PVJX W40 NANCE F/NxN e�3A SEP 2 9 2021 d. Period Begin 8"k P0, Balance d. Period Begin Balance 9y. RECEIVE s CERTIFICATION I certify that the Committee or Fund is in compliance with all applic le provisions of Article 22A, 22B, & 22D -22M of Chapter 163 of the NC General Statutes and that no funds are commingled with pr i /ted o ther dis sed funds. t further certify that this report s complec� true and corrst and that 1 have been trained by the S to eaio 0,4966 t L/S0cv54/ Printed Name of Signer L -SignatufWppo nted masurer Date 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 -E) to make committee changes. CRO -1000 NC State Board of Elections August 2008 %mendment Detailed Summary) es F Use this form to summarize all disclosure reporting forms and to total monetary information. s Z. T of Re ort wS�SeNMe glyTotal Number Cycle: January 1,Re LCash this ortin Period Total this Election C cle 5) 6) 7) 8) 9) 10) 11) at Start Aggregated Contributions from Individuals (CRO -1205) Contributions from Individuals (CRO -1210) Contributions from Political Party Committees (CRO -1210) Contributions from Other Political Committees (CRO -1130) Loan Proceeds (CRO -1410) Refunds/Reimbursements To the Committee (CRO -1240) Other Receipt Sources Ila) Interest on Bank Accounts (CRO -1150) I lb) Contributions from Not -for -Profit Organizations (CRD -1150) I le) Outside Sources of Income (CRO -1250) lld) Legal Expense Fund — Other Sources (CRO -1170) 11 e) Exempt Purchase Price Sales (CRO -1265) $ . 00 $ 5.00 $ 0.00 $ —.50.00 $ Q�o $ 03 t�,6 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12) TOTAL RECEIPTS(Addlines 5.6.7.8.9. 10. Ila. llb, 11c. lldand lie) $ 3 ,�{p $ 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 -1310) In -Kind Contributions (CRO -1510) $ cgs. 00 $ 3/0, 00 $ $ $ $ $ $ $ $ $ $ $ 18) TOTAL EXPENDITURES (Add lines 13a. 13b. 13e, 14. 15. 16 and 171 $ 19) 20) 21) 22) 23) 24) 25) 26) 27) 28) Cash on Il and at End (Add lines 4 and 12 together. then subtract line 18) Non -Monetary 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 Commi 0-1610) �J4LGQUN� Account Transfers Within the CommittepAMPAIGN FINAP&b�1720) Administrative Support —SEP 2 9 202(VRo-1710) Forgiven Loans RECEIVeK1440) 48 -Hour Notice Reports Sum (Ro 1110) Contributions to be Refunded (CRO -1215) $ Ip, ,Dy $ 7J/. OD $ $ $ $ $ $ $ $ $ $ $ $ $ CRO -1100 NC State Board of Elecions August 2008 Amendment Contributions from Individuals Pg or / Yes ❑ No Use this form to report individual contributions over SAO or contributions under $50 if form CRO 1205 is not used ommittee Full Name(and Fund ifa cable - I -+A -2-4 Wbf*W x M'C Loy k4t-1-) 3. Contributor Information ❑ Add ❑ a. Full Name. Hailing Address & Phone b. Job Tine/Profession (include cin', state, &zip) _ (T .JEmployer's Name/Specific Field /��Rmlbro.r-LOf�v✓! WA'XMW, NC a6'73 kk�cs 5 iSN d. Comments e. Election Sum to Date $ E Prior it. Account Code It. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ c AIM eAfrw s y Od 2w1 $ 44,7 03 ❑tj &chrpS $ 107, 0 3 ❑ 3. Contributor Information a. Full Name. Mailing Address & Phone (include cit), state. & dpl dd b. -Job Title/Profession $ d. Comments c. Employer's Name/Specific Field e. Election Sum to Date E Prior g. Account Code h. Form of Payment i. In -Kind Description j. Datt (mm/dd/yyyy) k. Amount ❑ $ ❑ a. Full Name. Mailing Address & Phone (include city, state, &zip) UNION COUNTY $ b. Job Title/Prolimion d. Comments SEP 2 9 2021 RECEIVEDe. c. Employer's Name/Specific Field Election Sum to Date $ E Prior g. Account Code It. Form of Payment I. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ $ ❑ $ $ .� 5. Total of ALL CRO -1210 Pages R (This line must be online 6 of Delailed Summary Page CRO -1100). n $ / 77 D� (CRO-121ll NC State Board of Flections -vpnI 'o Amendment Disbursements Pg 1 of —1 Yes ❑ Nn Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated pam expenditures. 1.Commi ame and Fa livable LL ff WOUjL 3. T of Disbursement P ase useseparate CRO -1310 forms ryzr:u un, I spamG� ❑ ('nnl n bllnnlL. m Political ( nnunu(ts )rdmated Pam L I)Cndrlurc. 4. Payee Information Add a. Full Name, \tailing Address & Phone (include city, state, & zip) h. ('oordinated Committee Name it. Comments 7�'Gv7 Is'Y N h`� N4 7 -;3 �5-4 NA -X AWj NC ati - 3 c. Level Registered (Specify) ❑ Federal El County: El State 19LMunicipality: e. Election Sum to Date $ 3be o0 f. Account Code g. Form of Payment b. Purpose Code i. Date (mm/dd/yyyy) j. Amount L Required Remarks t1xv`,�1'j C45F4 4 op �r abs/ $ l�i.00 B�f cirri wxwkl 0 -*94 o $ /1-W Add a. Full Name, Mailing Address & Phone b. Coordinated Committee Name include city, state, & zip) c. Level Registered (Specify) ❑ Federal ❑ County: El State ❑ Municipality: c d. Comments It. Election Sum to Date f. Account Code g. Form of Payment b. Purpose Code i. Date (mmldd/yyyy) J. Amount L Required Remarks S 4. VWWWtfiation a. Full Name. )tailing Address & Phone (include city, state,&zi W NIUN COUNTY Re b. Coordinated Committee Name it. Comments CAMPAIGN FINANCE SEP 2 9 2021 RECEIVED° e. Level Registered (Specify) ❑ Federal ❑ County: State ❑ Municipality: a Election Sum to Date $ L Account Code g. Form of Payment b. Purpose Code i, Date (mm/ddlyyyy) j. Amount L Required Remarks 5. Total only this Pae F$ O 6. Total of ALL CRA 1310 Paaes ("Chis line goer in line l3a uJ Detailed Summary Page CRO -1100 if Operating Expenaes) S (This line goes in line 13b of Derailed Summary Page CRO -1100 if Comrib to Candidates/Political Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) r ose d in it, A* - Media B* - Printing C* - Fundraising D - lb Another Candidate E - Salaries F* - Equipment G - Political Pam H* - Holding Public Office Expenses 1 - Postage J - Penalties K* -Ofce Expenses Q* - Donation to Legal Expense Fund O* - Other CRO -1310 NC State Board of Elections December 2009 In -Kind ContributionsPg / of AmenVesd y at No Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund. Ilse CRO -1? 1 i if In -Kind Contributions \x ere or will be refunded within 7 days. 1. Committee Full Name (andim if applicable) H-4t,j,+wA�K t+ -#W (D1vM0cwy 3. Contributor Information El Add El Remove a. Full Name. Mailing Address & Phone (include city. state. & zip)n b. "type of Contributor c. Comments Individual 1's�,j,. Candidate ❑ Party. ❑ PAC ❑ Referendum ❑ Other Receipt Source f�N MC(tI-� ,P PhD 5dd /ft` 14V I r"rl'�� L�U� wA xt*W NC _D-Yrt -7 3 it. Election Sum to Date $ 93y. // / e. Description E Date (mm/dd/yyyy) g. Fair Market Amount 0*400AAMP Cir"& n/ YN441bNS pyo $ Alle7, 03 CMUDt we LMrmia# yH4 Sly $ 1/427 03 0 W& tri bastor a. Full .Name. )failing Address & Phone (include city, state, & zip) b. Type of Contributor $ e. Comments ❑ Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source d. Election Sum to Date $ e. Description E Date (mm/dd/yyyy) g. Fair Market Amount a. Full Name. %failing Address & Phone (include city, state, & zip) b. Type of Contributor c. Comments ❑ Individual ❑ Candidate ❑ party ❑ PAC ❑ Referendum ❑ Other Receipt Source UNIUN COUNTY CAMPAIGN FINANCE SEP 2 9 2021 RECEIVED d. Election Sum to Date $ e. Description E Date (mm/dd/yyyy) g. Fair Market Amount $ $ $ e $ JjWg RO-1510 Pages $ His line mow be on line 17 of Detu fed Summnn Page CRO -1100) CRO -1510 \C State Board of Elections December 2007