Hall,Jason_2021-Year-endArnendruent
Disclosure Report Cover o Yea ❑ No
Use this form for general report and committee information, must be signed and submitted along with other detailed forms.
Do e t6i, inm. to , odntP infnrmatinn
-
. Comaduee Information
. M Name
c. ID Number
FFA(-l.4WAXFtAW _JASON mccL I' FLAt-l_)
. Mailing Adds® padade Cky, Slde ad ZIP Cade) _ _
& Date I74d
100 WAxhaw ParIzWol u, Ltl t 606
elibme Number -
WaXI'law, NC 28133
�O�¢-39�'-933'1
LftoqYear3 Peelod Stat Date _ 1 Period End Date s. Trea sweir Fog NUN
2021 10/19/2021 12/30/2021 JasOw MOCJ OId Rall
FTTW of CotteeCheerier One
of (check only ane type rt m one category)
El Candidate Campaign Party
Muoidpat
statdcomry
Rdersadum
❑ PAC ❑ Refenadum
❑ organ nonsd
D Organiratusud
❑ Orpmranonw
❑ Independent Ezpendinue ❑ Join Fundraiser
❑ Thirty-five day
Quarterly
❑ Pre-fawalum
❑ legal Expenae Fund
❑ Prc palmary
❑ First
❑ Final
❑ Pre-election
❑ Pte --roti
❑ Second
❑ Third
❑ Supplemental Final
❑ Annual
7. Type Of Irma (ffapplicaW darkaar)
Booster Fund
Semi-annual
❑ Fourth
❑ Speeial
❑ Building Fund
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
❑ Other:
® Final
❑ Special
❑ Year End
❑ Final
of Fundraisers this Report_
_Number
❑ special
11. Account Information 11. Account Infunuadou
Floaodal IartlOutim Fall Name &F modd inWaWm Fog Nanue
-
"h T11Lrd Bawl¢
b. Purpose
c.Aacemt Gale Partmee
AWOW Clic
.--- _
Hwxwol
caaupa gw Fiwawce
d.PerwDtde BNlww
a" 6xpewses
d. Period Begin Balance
$
$ 6095
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 ere commingled with prohibited or other non -disclosed funds. I further certify that this
report is complete, true and correct and that I have been trained by the NC S Board of Elections.
f asow MOCIoI� HaU. A"�� 12/30/2021
Printed Name of Si SuitAut of Appointed Treasurer Date
R OFFICE USE ONLY
Z3�--- Delivery Method
Date Received: EmP Normal Mail
Mail
Date Postmarked: Employee: dDelivered
❑ Electronically Filed
ED!
Date Scanned: Employee:
4�—a
❑ Signer has not received
Date Data Entered: Employee: mandato tramin
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-210HA-E) to make committee than
CRO -1000 ric ansa uaaru m M.6 . C • •-e-•
UNION
CAMPAIGN
JAN 2 S 2022
RF(-,rIVE0
Amendment
Detailed Summary ❑ Yes 0 No
T Ica r6:c form to m,mmarive all dicrincnre renn"ina Fnrtns and to total mnnetary intnrmation
1_ . Committee Fail Name land Focal If sippillizable)
2
RNRI.
rt
3. ID Number
1+RLL+WRXH.4W -JASON hi=CL y HRI.L)
Start of Election Cycle: January 1,
Reporting
Total this
Period
Total this
Election Cycle
4) Cash on Hand at Start
$
$
RECED'TS
5) Aggregated Contributions from Individuals (CRO -1205)
6) Contributions from Individuals (CR41214)
7) Contributions from Political Party Committees (CRO -un)
9) Contributions from Other Political Committees (0141330)
9) Loan Proceeds (0141414)
0) Refunds/Reimbursements to the Committee (CRO -1240)
1) Other Receipt Sources
Ila) Interest on Bank Accounts (CR41254)
11b) Contributions from Not -For -Profit Organizations (010-1254)
11c) Outside Sources of Income (CRO -1250)
lid) Legal Expense Fund - Other Sources (CRa1270)
Ile) Exempt Purchase Price Sales (CRO -1265)
$ 0.00
$
5.00
$ 200.00
$
1, 5 .O6
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
I $
12)TOTAL RECEIPTS (Add lines 5,6,7,8,9,10,11x, 116, 11c,1 Id and l le
$
200.00
$
1, 64.06
ENDITURES
) Disbursements
13m) Operating Expenditures (C141314)
19b) Contributions to Candidates/Political Commi#m (CRO.1314)
13e) Coordinated Party Expenditures (0141314)
4) Aggregated Non -Media Expenditures (CR41315)
15) Loan Repayments (CZ4If34)
6) Refunds/Reimbursements from the Committee (08413201
17) In -Kind Contributions (CRO -1510)
$
26095
$
"4.00
$
$
$
$
$
$
$
$
$
$
$
$
$) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$
260.5
$
1, 64.06
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$
0.00
$
0.00
DITIONAL 1NFORMATION
20) Non -Monetary Gifts Given to Other Committees
11) Outstanding Loans (incl. ones from other campaigns)
Debts and Obligations owed by the Committee
Debts and Obligations owed to the Committee
Amongst Transfers Within the Committee
Administrative Support
Forgiven Loans
411Hour Notice Reports Sum
(CRO -1330)
(CRO -1430)
(CRO -1610)
(CR4/620)
(CRO -1720)$
(0140.1714)
(caoa440)
(CRO -2220)
$
$
$
$
$ $
$ $
$ $
128) Contributions to be Refunded
(CRO -1275)
$
$
CRO -1100 NC sUte uoem of aacuare IN Hogue, cwo
� F'IC I
JAN Z 8 i 1ON COUNTY
PAI( -,N Pit'lA rr
RECEIVED? A
Amendment
Contributions from Individuals Pg ? f ? ❑ les ❑'No
Use this form to report individual contributions over $50 or contributions under S50 if form CRO 1205 is not used
. Committee Full Now and Fond if aMHclii11li1_
ID Number
12.
HAILAWAXFtAW _()ASON MCrr y HALL)
3. Contributor Information 13 Add Remove
a. FWI'Name, Moiling Add. & Phone
(include a ty, alatc, & zip)
b. Job 7113&Profermon
rr uxeeu.tLve
d. Comments
_ ...
)asow McC,011 H%1U
2660 Souther%Traoe rw
WQ)chQw, NC 2813
c. Eeplayr'a NaodSpedac Field
ROPLi "'OoMeAt
SOIAatI DKS, I IAC.
NAICS#: 541511
a. FJrtloo Sam b Dote
$ 425.00
.Prior
g.Aeeamt Oedc
LFanadPalmest
Lfe-Find Dwmz%dwo
Date(mNdNyyyy)
LAMM*
❑
FtXW01
CASK
10/22/2021
$ 200.00
❑
$
❑
$
. Contributor Information Add 0 Remove
w. Fall Name, Mailing Addrea,&Pbeee
(include city, state & rip)
b, Job 77tldPrdemim
d. CattNOWta _.
c. &apbyer's NaeadSpedfic Field
a. madlm gwiDAN
S
. Prior
❑
g. Account Code
_.
h. Form of Payment _
1. to -Kind DnaipWo
__
1. Date (aNd&yyyy)
IL AMM
$
❑
$
❑
$
. Contributor Information ❑ Add ❑ Remove
. Full Name Mailing Addren & Bunn
(imide d4, slate. & stp)
b. Job IldelProfenion
d. Commaat
c. Baeployr's NamaSpecific Plaid
ddir am is Date
$
Petr
ti.AcammiCleftrrrdepay
1111NO a
raidtW
Dde(maMdfyW)
LA=wd
13$
11$
El$
4. Total only this Page
$ 200.00
Total of ALL CRO -1210 Pages
(yhis line nart be on lire 6 o Detailed CRO.11001
$ 925.00
CRO -1210 NC Stile Board of Elections APnI 201[1
Amendment
Disbursements Pg i of i O Yea C3 No
Use this form to report expenditures from the committee for operating expenses, contributions to csodidate/political
co WIW IILLi 1LlLL tAlVl Wem.cuPH
I. o treeFull Name If e
-Furld
htALL4WAXHAW JASONMCCLOYFALL)
3. Type of Disbursement (PIas tse seaa. op CRO 1310 foram for saes test oflAtriurreateaR)
tin Ex �Coalnbadoa6 m Caadidams/Polidcal Committees Coordinated Party E 'tares
. Payee Informatims U Add U Remove
a. Full Name, Mailing Address & Phone
irclade )-
�i. f �h T -h" Bawle
8100 IC.es4i cjt:ow Dr
N4YL354
WaXhaw, 1,1028173
b. Camdiaated Committee Name
d. Cunaomb
c. Level Registered (Specify)
0 Federal E YCamey:
❑ state ® M®cipality.
e. Nation Sm to Bade
Aermm Code S.Farm atPsyment b. Furpas Cade
tml E Required ll®mb
L Dale (�IddFT-7
F)WXW CASH O
11/10/2.00 "NIG �E@S/0"AR.c
HWXWO GASH O
1?110/.00 ERNK. FEES/C!-FRR.CiE
Payee Information OAdd 13ReMDVC
s. Full Name, Mailing Address & Phone
(include city, Wte, & ZIP)
waAaw Athletic Assooi ldow
b. Coordinated Comndttee Name
d. Co®ents
c. Leal Registered (specify)
Pedmel Camry:
❑ side Maeicipality
e. FJMkn Smto, DMe
$ 12095
Aaamt lYie
9.7a OCP"=00
k. Purpose Cele L lade )
A::
L Required Re�rb
HWXWOi
CF)ECVC
O L2/30/20=
$ 12.095
Closing Rocouwt/
Is
Now -pr&ftt cowtri u w
, Payee Information Add Remove
a. Fail Name, Mailing Address & Phone
(hxhmk city. date, Jk zip)
Mint FiUL T- etas
7427L Matthews m4At Hill RA, SIA(.te 108
M%wt Hill, NC 2822-862
b. Coordinated Committee Name
d. Co®eats _.
a Level Registered (Specify)
Fadr� Caant3I
❑ state is Mumdpality:
e. Weeds Sam to Date
$ ioo.00
r.AawamiCede 6 Fa0m 9fPaymmmtt
Irmpom Cade
Dob (�tddlyyyy)
Ama"Wt�kRequlredY�da
HWXW 11CASH
A
10/26/2021
$ 100.00Vert%siwg/Media
. Total only this Page
$ 26095
. Total of ALL CRO -1310 Pages
(7his line goes in line 13a of Detailed Summary Page CRO -1100 if OPerating Expenses)
(7his Use goes is line 136 of Detailed Summary Page CRO -1100 if Conaib to Candidates/Polisical Comm)
(This liar goes in Gee 13c of Detailed Summary Pae CRO -1100 i Coardinafed Party Lr endUures)
$ 994.00
7. Purpose Codes (List detailed expenditure code in (h.) above)
• - Media R' - Printing Ca - Fundraising D - To Another Candidate
E - Salaries F' - Equipment G - Political Party H* - Holding Public Office Expenses
I Postage 1 - Penalties Ke - Office Expenses Q' - Donation to Legal Expense Fund
• Other
• I Med rennire detailed emlaoation in regaired remarks field W
Im—
MMI 311) NC Slate Board of Sections December 2009