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Hall,Jason_2021-PreElection-amendmentAmendment Disclosure Report Cover I \'ea ❑ No Use this form for general report and committee information, must be signed and submitted along with dfheT detailed fortes. Do not use this form to update information CRO -1000 NC State Board of Elections August 2008 a. Full Name e. ID Number Pr -L4 4y 4AW.TtA:sdN /UC C b. Mailing Address (include City, State and Zip Code) d. Date Filed v�,A-xy�"4V v_ *-wAy, chic 666 w/'/o�o�/r4 " 04-X"J NO— O' -?/-7_3 e. Pbooe Number -7 ass -5-777 2. Report Year 3. Period Start Date (mm/dd/y),) 4. Period Ender Full Nam mm/d iy l D. i gi F Li see-wSKI Candidate Campaign ❑ Party 9. Type of Replarl Municipal check only one npe o re on rota one tate o State/('ount) Referendum PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational Independent Joint El Expenditure E]int Fdi Thirty-five da ❑ rtY` Y Quarterly ❑ Pre -referendum Legal Expense Fund ❑ Pre-primary ❑ First ❑ Final ❑ "Booster Fund" ❑ Building Fund Preelection Pre-mnoff ❑ Second ❑ Third ❑ Supplemental Final ❑ Annual Semi-annual ❑ Fourth ❑ Special ❑ Mid Year Semi-annual ❑ Other: ❑ Year End ❑ Mid Year ❑ 1 incl ❑ Year End �. ❑ Special ❑ Final N 0 N F, ❑ Special 11. Account Information a. Financial Institution Full Name a. Financial Institution Foil Name f b. Purpose c. Account Code b. Purpose c. Account Code C_AM�/PA*'/d P (r � K S 4PJA e ^'NC e� �•'�i i f�N/Xw 1 d. Period Begin Balance d. Period Begin Balance $�g oo 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 INC General Statutes and that no funds are commingled with proh' ed or ther n-disclo d funds. I further certify that this report is complete, true and con)qct an that 1 ve been trained by the N _�IcFL f- �IS6WK�f t e Bo ctions. Printed Name of Signer AF Date FOR OFFICE USE ONLY Date Received: {Jd�f/�_ Employee: 1� 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 UNION COUN 04APAIGN FINAtd. Detailed Summary (` � Use this form to summarize all disclosure reporting forms and to total monetarv%T 2af 2021 \ III elid III ent ❑ N e, Z5 M CRO -1100 VC State Board of Elections August 2008 Fu if a licable 2. T + .T�g mltwtion e of Re 3. ID Number"I+A Cycle: January 1, ti°a) Z4)Cash Total this Re ortin Period Total this Election C cle 5) 6) 7) 8) 9) 10) 11) 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 Its) Interest on Bank Accounts 11b) Contributions from Not -for -Profit Organizations Ile) Outside Sources of Income lid) Legal Expense Fund — Other Sources 11 e) Exempt Purchase Price Sales (CRO -1105) (CRO -1210) (CRO -1220) (CRO -1130) (CRO -1410) (CRO -1240) (CRO -1250) (CRO -1150) (CRO -1250) (CRO -1170) (CRO -1265) $ $ feLf. Q 0 $ $ it 5.00 $ 'l,' s $ 17, 59. tO $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12) 13) 14) 15) 16) 17) TOTAL RECEIPTS (Add lines 5.6, 7.8.9, 10. Ila. I1b. IIc. 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 -1320) In -Kind Contributions (CRO -1510) $ 7AS, 00 $ ' -71, ,O $ 7331 v.) $ $ $ 7 IDS $ $ $ $ $ $ $ $ $ $ 34,0 18) TOTAL EXPENDITURES (Add lines 13a. 13b, 13e, 14. 15. 16and 17) $ ,Q,.qr $ 1-7 03. 11 11 19) Cash on Hand at End (Add lines 4 and 11 together. then subtract line 18) $ 60, 9 $ aa3,7A 20) 21) 22) 23) 24) 25) 26) 27) 28) Non -Monetary Gifts Given to Other Committees Outstanding Loans (incl. ones from other campaigns) Debts and Obligations owed By the Committee Debts and Obligations owed To the Committee Account Transfers Within the Committee Administrative Support Forgiven Loans 48 -Hour Notice Reports Sum Contributions to be Refunded (CRO -1330) (CRO -1430) (CRO -1610) (CRO -1620) (CRO -1720) (CRO -1710) (CRO -1440) (CRO -2220) (CRO -1215) $ $ $ $ $ $ $ $ $ $ $ I $ $ CRO -1100 VC State Board of Elections August 2008 Amendment Contributions from Individuals 119 / „f X les ❑ so Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Full Name and Fund if applicable) W % 44 f J��rnl Pl %4z dL 3. Contributor Information a. Full Tame, Mailing :Wdress&Phone (include city, state, & zip) R b. Job Tide/Profession d. Comments` N a .7Va,-.Ti.aF NI j4�rl- yyoNS M/ fht,N�ON S. LLC. f"O FW WAxn/, tuL` ��n3 c. Employer's Name Specific Field JVoTEAAPZY&-b e. Election Sum to Date $ 5'04).466 f. Prior Account Code It. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount El1 {{g. ' ttv X Wp(j C µ'tin /� �% aq�.� $ S-vO, O ❑ $ ❑ 3.` ontr utorinforroation a. Full Name, %[ailing Address & Phone (include city, state, & zip[ dd ❑ Rem" b. Jab "Title/Profession $ d. Comments �- IT ExEt_u�r✓t M �� c�y�� ��� �� 6 5 0 ; �[ � d,.. rL�l. /z N %. -� pn •7 �l �T'>•"� 1... d'c 7 c. Employer's Name/Specific Field IWAD AG1/E14L'iPM4W17 !) CA-U—Pw ( S /v*CS4--5-,/S�l e. Election Sum to Date $ ao f. Prior g. Account Code It. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ HWXW C to o� atm/ $ A")S. d.)o ❑ $ 3. Contributor Informatjo a. Full Name, )tailing Address & Phone (include cit%, state, & zip) It. Job Titie/Professhm 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. Date (mm/dd/yyyy) k. Amount ❑ $ ❑ $ 4. To ` 'oaiy - .. Wge $ -7g:;k,5-. 5. Total of ALL CRO -1210 Pages 7a� p0 (This fine nme/ he on line 6 of Derailed Summary Page CRO -1100) ( RO-121 /l N(Statc Board of Elections April 2007 Amendment eeeyyy bi$bursements Pg of ❑ Yes Nu Use this form to report expenditures from the committee for: operating expenses, contributions to candidate/political committees and coordinated pirtN expenditures. 1. Committ Name and Fu d if a lieable t-fAr-L4ALI 3. T e of DisbPursement ease uses orate CRO -1310 ohms llperning I yxnsc� 14 PvT1MRRwJFW- (''nlrihtjtionx to (andidale. Polilic'd t-bmmittees ❑ (lmrdinxc,l Parr Prpendinues 4. Payee Information n Add Nowhamilliol.. a. Fall Name. \lalling Address & Phone include city, stale. &zi b. ('oordinated Committee Name d. Comments CAMPAU. �CONN OCT 25 202 E C E I V F► fen 13 X le 0 !4r1V5t N(ru A(P2(VE N4 35 A- NA-)L&A'NJ (V L c. Level Registered (Specify) E] Federal County ❑ State 54 Municipality: e. Election Sum to Date $ #7 00 E Account Code g. Form of Payment It. Purpose Code —Ti. Date (mm/dd/yyyy) j. Amount k. Required Remarks HrvxW / CA-< t� p /%3 l $ m -t o F471e-5 $ a. Full Name, Mailing Address & Phone (include city, state. &[ zip) b. Coordinated Committee Name d. Comments V prv� $6�-8�3G7�3 c. Level Registered S � (Specify) ❑ Federal ❑�p County: [3State[g Municipality: e. Election Sum to Date zf$ .955. D..—L- f.. Account Code g. Form of Payment It. Purpose Code i. Date (mm/dd/yyyy) j. Amount Is. Required Remarks 1 64$ff $e CAUKS -'i ee Inform", a. Full Name. Nailing .Address & Phone include city, state. & zip) R b. Coordinated (nmmillee Name d. Comments 5)&N-5 N6UJ p p4wflOFf �l L e. level Registered (Specify) ❑ Fedemt ❑ County: State Municipality: a Election Sum to Date L Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k Required Remarks +iyv $ to D� .^a l s44-76-3 4m(s t 16AJS $ S.To $ ,p & To 1310 Poe" (This line goes in line /3a ul Detailed Summary Page CRO -1100 if Operating Expenses) $ S(Thu(This line goes in line lab of Detailed Summary Page CRO -1100 if Comrib to Candidates/Polidcal Comm) 133, 05— (This line goes in line 13c of Detailed Suoumty Page CRO -1100 if Coordinated Parte Expenditures) Codes a in h. above A* - Media B* - Printing C* - Fundraising D- To Another Candidate F. - Salaries F* - Equipment G - Political Parp H* - Holding Public Office Expenses I - 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 Slate Huard of Flections December 2009 GE N