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Hall, Jason_2021-midyear%mendment Disclosure Report Cover ❑ in X 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 1. Commi a. Full Name e.ID Number f+.4",+ WAxW ,*W (.T*5o ► MP-CiAy i*w-, b. Mailing Address (include City. State and Zip Code) it. Date Filed 10,t wMtFf�tw PAAKwi4y) u"tr Loi 0 2o1 -713 i " (rtt W NJC— K1 -73e. Phone Number -7014 - 2SS-5-797 2. Report Year 3. Period Start Date (mm/dd/%N) 4. Period End Date 5, Treasurer Full Nam (mm/dd/ . DArvl Et- F. L15EK / �a 1 of Committee Check One 9. Type of Report check only one ' Candidate Campaign ❑ Pam Municipal State/Count" Referendum ❑ PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational Independent ❑ ❑ Expenditure Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre -referendum Legal Expense Fund ❑ Pre-primary ❑ First ❑ Final ❑ "Booster Fund" ❑ Pre�elcction ❑ Second ❑ Supplemental Final ❑ Building Fund ❑ Pre -runoff ❑ Third ❑ Annual Semi-annual ❑ Fourth ❑ Special NLMid Year Semi-annual ❑ Other: ❑ Year End ❑ Mid Year 1 e ❑ Final ❑ Year End IS ❑ Special ❑ Final ❑ Special 11. Account Information 11. Account Information a. Financial Institution Full'Name a. Financial Institution Full Name 1 T*(P-i> N FIFTH -rftlea K b. Purpose c. Account Code b. Pur c. Account Code f`Itwx W X1(1 CAMPAIGN FINANCE �WX w�I JUL Z 0 2021 d. Period Begin Balance d. Period Begin Balance S o. oo RECEIVED CERTIFICATION I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B, & 22D -22M of Chapter 163 of the NC General Statutes and that no funds are commingled with pro i ed or ther non-disclo d funds. I further certify that this report is complete, true and correctnd that I have been trained by the N tat B tions. DAWIF,L. w5cyiilt=1 7 i19 j2021 Printed Name of Signer ignature of Adp nted Treasurer Date FOR OFFICE USE ONLY Date Received: 020 Employee: Delivery Method ❑ 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-210OA-E to make committee changes. CRO -1000 NC State Board of Elections August 2008 %mendmem Detailed Summary El le, A No Use this form to summarize all disclosure reporting forms and to total monetary information. committee Full Name and Fund if applicable) 2. Type of Report 3. ID Number t+orw 4 WA's OkW Cr�r aoj f 1 ► M(DMl � L Start of Election Cycle: January 1,► Total this Reporting Period Total this Election Cycle 4) 4;) 6) 7) 8) 9) 10) 1 l) 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 I la) Interest on Bank Accounts 11b) Contributions from Not -for -Profit Organizations Ile) Outside Sources of Income 11d) Legal Expense Fund - Other Sources 11 e) Exempt Purchase Price Sales (CRO -1205) (CRO -1210) (CRO -1220) (CRO -1230) (CR04410) (CRO -1240) (CRO -1250) (CRO -1250) (CRO -1150) (CRO -1270) (CRO -1165) $ 6.60 $ q 0o $ 5, 00 $ S.00- $ OO , 00 $ 100.00 $ $ $ $ $ $ $ $ S $ $ $ $ $ $ $ $ $ 12) TOTAL RECEIPTS (Add lines 5.6,7,8.9,10,Ila. Ilh.Ile. lldandIle) $ lOS,00 $ 105,00 13) 14) 15) 16) 17) Disbursements 13a) Operating Expenditures 13b) Contributions to Candidates/Political Committees 13c) Coordinated Party Expenditures Aggregated Non -Media Expenditures Loan Repayments Refunds/Reimbursements From the Committee In -Kind Contributions (CRO -1310) (CRO -1310) (CRO -1310) (CRO -1315) (CRO -1420) (CRO -1320) (CRO -1510) $ 11.00 $ Ll , 00 $ $ $ $ $ $ $ $ $ $ $ $ 18) TOTAL EXPENDITURES (Add limes 13a. 13b. 13c. 14. 15. 16 and 17) S I11-00 $ 11.60 f9) ANEW 20) '-I) 22) 23) 24) 25) 26) 27) 28) Cash on Hand at End (Addlines 4 and 12 together, thensubtract 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 Committee (CRO -1620) Account Transfers Within the Co- (CRO -1720) Administrative Support GP.ti4PA)GNO) 2021 (CRO-rn0) Forgiven Loans )�iL 2 (CRO -1440) 48 -Hour Notice Reports Sum c ! EIV �D (CRO -2220) Contributions to be Refunded R (CRO -1215) $ Q tf,00 $ t}, 00 $ $ S $ $ $ $ $ $ $ $ 1 $ $ CRO -1100 NC State Board of Elections August 2008 Amendment Aggregated Contributions from Individuals Page 1 or I les "o Optional form used to report NC Contributions From Individuals of $50 or less e (and Fund M M L M Number N -A -+-L Zr W A-)c4A W M0c 3. Contributor Information b.%camnt a.Amend ( de C. Formof Pa., mensmm/dd/ tDa, Add Remove WX W�� C 7In-10ade. DateLAmount 06-111 00.01 $ 9.0O Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Cj Remove Add $ Remove ❑ Add $ Remove Add $ Remove Add S Remove Add $ Remove Add $ Removey demove ct U1`U F�G� F1NPN $ - — R v (- Remove Add �\ Cj $ Remove Add $ Remove 4. Total only this Page $ S7.00 5. Total of ALL CRO -1205 Pages (This line must be online S of Detailed Summary Page CRO -1100) $ 5.. OO CRO -1105 NC State Board of Elections April 2007 Amendment Contributions from Individuals 1'9 of / 9 les ❑ No Use this form to report individual contribution, avrr 590 or contributions under S50 if torm CRO 1205 is not used Ijcable) T,asaN M°Coy ru 3, (-:ontrjbutQr:IDrormation- , - [01&d a. Full Name, ytailing Address & Phone (include city, state, & zip) . b. Job Title/Profession d. Comments ►'r Ex EGLirr v -ro 4oe2R@6T wrr/.t SL3PA a rkL i o *D"D,�, ��TT�j�AAPs�+�s�s NMIt fir IGt �t�Dfc � A -C ON CCMS� we"Y tN� u— ( c7vV II/LlN I /�_ DO&Vf HG "— ( 4-x f *w) N C � 0 (-) 3 c. Employer's Name/Specimc Field �1 D D Evellewfw'r N50 wn 5 S57( t. Flection Sum to Date $ 100.00 E Prior g. Account Code It. Form of Payment I. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ Ryvxw l C tCLK 06 z'T ( $ 100.60 ❑ - $ 3. Contribute - a. Full',ame.>lailing Address&Phone It. Job Tine/Profession d. Comments (include city, state, & Ap) c. Employer's Name/Specific Field e. Election Sum to Date $ f. Prior g. Account Code It. Form of Payment 1. in -Kind Description j. Date (mm/dd/yyyy) k. Amount a. Full Name, Mailing Address & Phone (include city, state, & zip) It. Job Title/Professioo d. Commend c. Employer's Name/Specific Field e. Election Sum to Dalt $ f. Prior g. Account Code h. Form of Payment 1. In -Kind Deseriptioo j. Date (mm/dd/yyyy) it. Amount ❑ $ 4. Total only this P $ 5. 'Total of ALL CRO_-- f0'Pages $ ('flus line inow be on line b oj'Derailed Sunmmrr Yu;r CRO4100) ( HO- / _' 10 NC State noard til' tican, r., 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 partv expenditures. tee Full Name and Fund if a licable 2. ID NVWDW kx SfrSof'sj A� t'iL , - - ope f Disbursement Please use separate CRO 1310 ofms or each aline I'I..... ❑ l nninhuiwm to l'xndidate. I'ohlmal ('onlowlec, Coordm; tcd Pam I. \penditures kFII nformation I, )tailing address &Phone state. & zip)a Add Rem h. Cmtrdinated Committee'same d. Comments ,. _ , ✓ Pj b() KE�1 �( lrbn-f f 1 Int' V�McFtAr As(L )5173 c. Level Registered (Specify) E]Federal ❑ County: ❑ state Municipality: e. Election Sum to Date $ 11.00 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount Is. Required Remarks t WXWVJ CA -15,4 0 ob'jblao> 1 s 11.1)0 BA �►K F 5 549" s 4. Payee Information a. Full Ns mine, !flailing Address & Phone include city, state, & zip) Add b. Coordinated Committee Name it. Comments e. Level Registered (Specify) ❑ Federal ❑ County: ❑ state ❑ Municipality: e. Election Sum to Date L Account Code g. Form of Payment It. Purpose Code L Date (mm/dd/yyyy) j. Amount k. Required Remarks 4. Payee Information El Add a. Full'same, Mailing .Address & Phone include city, state, & zip) TY b. Coordinated Committee'same it. Comments UI, A. ati1PA1GFl FIN 1 1111 2 0 2�2ti UL. EGEIVE� c. 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 L Required Remarks S 00 Pape 1310 Pages (This If goes in line lin of Detailed Sunmmr, Page CRO -1100 if Operating Expenses) $ I I •OO (This line goes in line lab of Detailed Summar, Page CRO -1100 if Contrib to CandidatesiPolitical Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Part, Expenditures) 7. Pur We Codes ist dere' trade in ,above A* -Media B* - Printing C* - Fundraising D - To Mother Candidate F. - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses 1 - Postage .1 - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* - Other * Codes require detailed explanation in required remarks field k CRO -1310 NC State &mrd of Elections December 2009