Hall, Jason_2021-35DayReportAmendment
Disclosure Report Cover I ❑ Yes N' No
Use this form for general report and committee information, must be signed and submitted along with other detailed forms.
Do riot use this form to update information
1. Comm'
a. Full Name
c. ID Numher
F ALL 4 WAS+kW -T4t54n1VCcLoY4+Au
b. Mailing Address (include City, State and Zip Code)
d. Date Filed
1045 wA-%- AW PA49wAyt VNIT
9/,pT og4Z/
wAxr, Nen
e. Phone Number
row -ass -S? 1-7
2. Report Year
3. Period Start Date (mm/a
)mm/da
4• Period End Date
5. Treasurer Full Name
6. T of Comm
9. Type of Re
Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
Organizational
❑ Organizational
❑ Organizational
Independent Joint Fundraiser
❑ Expenditure ❑
-I hirt five da
5` Y'
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
FU
❑ Pre-primary
❑ First
❑ Final
❑ 'Booster I und"
❑ Pre-election
❑ Second
❑ Supplemental Final
Building Fund
❑ Pre -runoff
❑ Third
❑ Annual
Semi-annual
❑ Fourth
❑ Special
❑ Mid Year
Semi-annual
Other:
❑ Year End
❑ Mid Year
❑ Final
❑ Year End
❑ Special
❑ Final
❑ Special
11. Account information
11. Account
Information
a. Financial institution Full Name
a. Financial
Institution Full Name
1-rN(kj3
AW9' r -/F1-0 -r'tffgDhry
It. Purpose
c. Account Code b. Purpose
c. Account Code
4W,klA -1 CAMPAIGN FINANCE
d. Period Begin Balance SEP 2 8 2021
d Period B�� lance
�,
94REGEIVED
CERTIFICATION
I certify that the Committee or Fund is in compliance with all applicakAe provisions of Article 22A 22B, & 22D -22M of Chapter 163 of
ted or her no discio funds. l further certify that this report
the NC General Statutes and that no finds are commingled with4ignatur-of
is complete, true and correct and that I have been trained by thea do
PAwte , F. t-I56WSK/ of Bos
Printed Name of Signer med Treasifier Date
FOR OFFICE USE ONLY
!)
Date Received: �D a Employee: Delivery Method
E] Normal Mail
Date Postmarked: Employee: Registered Mail
Hand Delivered
Date Scanned: Employee: Electronically Filed
❑ Signer has not received
mandatory training
Date Data Entered: Employee:
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.
CRU -1000 NC State Board of Elections August 2008
Amendment
Detailed Summary ❑ Nes NO
Use this form to summarize all disclosure re ortin forms and to total monetary information.
1. Co' Fall N Fund if2. T
1+4rw 4 vvArf *w A56A,
llllllllly
J. ID Number
Start of Election Cycle: January 1, /�ib`�-�
Total this
Reportina Period
Total this
Election C cle
a)
RE
Cash on Hand at Start
$
$
0 ,
1
6)
7)
8)
9)
10)
11)
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
]lb) Contributions from Not -for -Profit Organizations
Ile) Outside Sources of Income
ltd) Legal Expense Fund—Other Sources
ll e) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1120)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
$
0,00
$
S
$ :7-N, Qb $
103Y. 610
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
12)
13)
14)
15)
16)
17)
TOTAL RECEIPTS (Addlines 5. 6. 7, 8, 9, 10. Ila, Ilb, Ile. Ildand Ile)
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)
$
3 ��
$
Q
$ 2S, QQ $
34 - 60
$ $
$ $
$ $
$ $
$ $
$ 3 Q $
y e ofo
18)
TOTAL EXPENDITURES (Add lines /3a, 13b, 13c. 14. 15. 16and U)
$
J / , D10
$
%Q, Q
19)
20)
21)
22)
23)
24)
25)
26)
27)
28)
Cash on Hand at F.nd (IJJ/m;,.1,012logether, thenmbiractline18)
INFO
Non-Monetan Gilts Ck en to Other Committees (CRO -1330)
Outstanding Loans (incl. ones from other campaigns) (CRO -1430)
Debts and Obligations owed By the CO(CRO-1610)
�}id+E3tu � IG€
Debts and Obligations owed 4AtJleaa'6+A4gug (CRO -1610)
Account Transfers Within the Clerllft % 20 (CRO -1720)
Administrative Support �E-GEA v L ED (CRO -1710)
Forgiven Loans (CRO -1440)
48 -Hour Notice Reports Sum (CRO -2220)
Contributions to be Refunded (CRO -1215)
$
$
$
$
$
$
$
0.00
$
$
/-1#. 00
$ $
$ $
$ $
CRO -1100 NC State Board of Elections August 2008
Contributions from Individuals Pg o, ❑ �Amendment� No
Use this Ibrm to report individual contributions ovei $50 or contributions under $50 if forni CRO 1205 is not u,cd
Fmmiftee Full Name (MV6d ifa Ijcaple) I2.
�A u 4 W*%,F`r*w SAN Ae c L b V. -)
ID Number
utor Information ❑
Add
_
d. Comments
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job l'itle/Profession
17- Exv `rr ��
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JA&N MCe Lsy f4A-L
��05 ��,//_
fv��/7 3 YrL
WR'X�W j AIC
Nam"
Nam1e/,S,p�ecific�sField�
/c�. �Em�pl*oyer's
KM'Y 56"1�c •tary I
6r,6
tvA iC S : .5-41511
e. Election Sum to Date
s /034 414
E Prior g. Account Code It. Form of Payment
I. In -Kind Description
j. Date (mm/dd/yyyy)
k. Amount
❑ l'wxk\Wl
$ A{G7. d3
❑ t W.XV e'► CA9f
o911-7 abz)
$ All, 7. of
❑
r'Iafa•ofa
a. Full .Name. Visiting Address&Phone
(include city, state, & zip)
b. Job Tide/Profession
$
d. Comments
c. Employer's Name/Specific Field
e. Election Sum to Date
$
I. Prior
g. Account Code
It. Form of Payment
I. In -Kind Description
j. Date (mm/dd/yyyy)
k. Amount
❑
$
❑
$
❑
3. Contributor informati
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
$
d. Comments
UN�OC\ p NPNG
GPMQP Q tp1�
SEe U 1 O
c. Employer's Name/Specific Field
e. Election Sum to Date
$
f. Prior
g. Account Code It. For [ I. In -Kind Description j. Date (mm/dd/yyyy)
It. Amount
❑ $
5. Total of ALL CRO -1210 Pages $ 937 b7
(This line must be on fine b of Detailed Sumnmpy Page CRO -1100) �l
CRO -1210 NC State Board of Elections April 2007
Amendment
Disbursements
Pg / of � ❑ Yes� No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
committees and coordinated party expenditures.
1. Commit Fund
RwNumber_
tbqj:j=- all W ArX
3, Tvne of Disbursement Please ses prate CRO-Li10 orms
rse
Im Upcotm, l_y,enx. ❑ llmtrihutium lu CnnJ nhttc. I'nliV:al l lmmtiih'e,
❑ Coordinated Parh l ,pend,m,.,
4. Payee Information
Add
Rem
a. Fall Name. 'llailing Address & Phone
b. Coordinated ('ummittee Name
d. Comments
include city, state, & zi
I�fffi TtZ1) $�✓K _
�() W 14 r, rv4-m� ^�' ,/C
�+ Gfv''�T/I ij�'j 1'
M7:3 S
KJA-3cf*A-W, A/C gr 3
c Level Registered (Specify)
❑ Federal ❑ County:
❑ State Municipality:
e. Election Sum to Date
$ 3& 0c)
E Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
Is. Required Remarks
t 'XWKI
C $*
o
o�/t+r 90»
$14.o0
i rNrWA
i WXVV61 CA51+ v
04 1131�lld21
$ I
t03 AWF-S
4. Pa '
a. Full Name, Mailing Address & Phone
It. Coordinated Committee Name
d. Comments
include city, state, & zip)
n Level Registered (Specify)
❑ Federal ❑
County:
❑ State ❑
Municipality:
e. Election Sum to Date
E Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/ yyyy)
j. Amount
k. Required Remarks
S
Add
g
a. Full Name, Mailing Address & Phone b. Coordinated Committee Name
d. Comments
include city. state, & zip)
c. Level Registered (Specify)
❑ Federal ❑
GPMQi'� Oq\ ❑ State ❑
EeZg1.L
County:
Municipality:
e. Election Sum to Date
f. Account Code
g. Form of Payment ode I i. Date (mm/dd/yyyy)
j. Amount
it. Required Remarks
$
5. Total only this Pse
g Q
6. Total of ALL CRO- . ,
(this line goes in line Ida of Dendled Summary Page CRO -1100 if Operating Expenses)
(This line goes in line 13b of Detailed Summary Page CRO -1100 ifComrib to Candidates/Polideal Comm)
S
(This line goes in line 13e of Detailed Summary Page CRO -1100 if Coordinated Parry Expenditures)
"se Codes a in h. above
A* - Media B* - Printing C* - Fundraising
D - To Mother Candidate
E - Salaries F* - Equipment G - Political Pam
H* -Holding
Public Office Expenses
1 - Postage J - Penalties K* - Office Expenses
Q* - Donation to Legal Expense Fund
O* - Other
Cdesnquire detailed ex laoatton in aired remarks lleld k
CRO -1310 NCState Board of Elections 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