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