Helms,Matt_2019-MY'Amendment
Disclosure Report Cover ❑Yes ® 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 u date information.
1. Committee Information
a. Full Name
c. ID Number
1
rn ;\}ea '\--o C\eolr Ma\k
b. Mailing Address (include City, State and Zip Code)
d. Date Filed
53tS 5 Zd<^y R•v<r RJ
-71231Zot9
e. Phone Number
-704-S-7Z-()LI5"4
2. Report Year
3. Period Start Date mm/dd/4. Period End Date mm/d
5. Treasurer Full Name
-10 % 0\
�►tlZvtq 6130120 to
M<Wt,.,. ),ti-
6. a of Committee Check One
9. Type of Report (check only one type of report from one category)
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
❑ Organizational
❑ Organizational
❑ Organizational
Independent Expenditure ❑ Joint Fundraiser
❑ Thirty-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑ Pre-primary
❑ First
❑ Final
❑ Pre-election
❑ Pre -runoff
Semi-annual
E3 Mid Year
❑ Second
❑ Third
❑ Fourth
Semi-annual
❑ Supplemental Final
❑ Annual
❑ Spo r�Iz �(1!7
`�LLSS �Vl
7, Ty e of Fund (if applicable, check one)
Booster Fund
❑ Building Fund
❑ Year End
® Mid Year
10. Special R rt N
❑ Other:
❑ Final
E3 Special
❑ Year End
❑ Final
10 Special
Union Co. Elect
8. Number of Fundraisersthis Report
i)
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
V%r,Or
. Purpose
a Account Code -
b. Purpose
c. Account Code
d. Period Begin Balance
d. Period Begin Balance
$ \\U.�O
$
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 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 State Board of Elections.
_t • \ ¢�N <y 1 Al- -7 12-� ('Z o t q
Printed Name of Signer SiRnature of Appointed Treasurer Date
FOR OFFICE USE ONLY
Date Received: *4111Employee: Delivery Method
E3 Normal Mail
Date Postmarked: Employee: Registered mail
Hand Delivered
Date Scanned: 8/9 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 -10011 NC State Board of Elections August 2008
=D
]ns
Detailed Summary
Amendment
❑ Yes M No
i t'r CC- kO L\44k M'\* " "N
m%A
lui-
$ \ � 6. o 0
Start of Election Cycle: January 1, 20 to
(CRO -1310)
$
Total this
Reporting Period
Total this
Election Cycle
4) Cash on Hand at Start
$
$
\\0. ° °
(CRO -1310)
$
RECEIPTS
5) Aggregated Contributions from Individuals
6) Contributions from Individuals
7) Contributions from Political Party Committees
8) Contributions from Other Political Committees
9) Loan Proceeds
10) Refunds/Reimbursements to the Committee
11) Other Receipt Sources
Ila) Interest on Bank Accounts
llb) Contributions from Not -Por -Profit Organizations
Ile) Outside Sources of Income
lid) Legal Expense Fund - Other Sources
Ile) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
(CRO -1315)
$
$
15) Loan Repayments
$
$
$
$
(CRO -1320)
$
$
17) In -Kind Contributions
$
$
$
$
$
$ 91
$
$
$ 110.60
$
$
$
$
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9,10,lla,llb,l lc,lld and Ile)
$
,e"
$ (/f
13) Disbursements
$
[
$ \ � 6. o 0
13a) Operating Expenditures
(CRO -1310)
$
$
13b) Contributions to Candidates/Political Committees
(CRO -1310)
$
$
13c) Coordinated Party Expenditures
(CRO -1310)
$
$
14) Aggregated Non -Media Expenditures
(CRO -1315)
$
$
15) Loan Repayments
(CRO -1420)
$
$ Union Co.
16) Refunds/Reimbursements from the Committee
(CRO -1320)
$
$
17) In -Kind Contributions
(CRO -1510)
$
$
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$ o
$ 91
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$ 1 0 , °
$ 110.60
20) Non -Monetary Gifts Given to Other Committees (CRO -1330)
21) Outstanding Loans (incl, ones from other campaigns) (CRO -1430)
2) Debts and Obligations owed by the Committee (CRO -7610)
23) Debts and Obligations owed to the Committee (CRO -1620)
24) Account Transfers Within the Committee (CRO -1720)
25) Administrative Support (CRO -1770)
26) ]Forgiven Loans (CRO -7440)
27) 48 -Hour Notice Reports Sum (CRO -2220)
$
[
$ \ � 6. o 0
$E
$
$
$
$
$
$
$
$
28) Contributions to be Refunded (CRO -1215)
$
$
2019
Outstanding Loans
Amendment
Pg of ❑ Yes ® No
Use this form to report any outstanding loans received during a previous reporting period and until the loan is paid in full.
1. Committee s`til'l Name (and if applicable)
2. ID Number
`Fund
3. Lender Information ❑ Add ❑ Remove
a. Pull Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Thle/Profession
d. Comments
't\o s�ncsl rM1�.tq s�
/
tt'IGnrut, jU (. 2iss�5
e. Start Date (mm/dd/yyyy)
c. Employer's Nnme/Specmc Field
\IA-Lor
City oC Cl..lN�
f. End Date (mm/dd/yyyy)
g. Rate
1h. Security Pledged
'.Original Loan Amount
J. Remaining Loan Balance
O %
No^h
$ ISV. n�
$ `F0, uD
IL Full Name of Lending Institution
1. Loan Number
3. Lender Information ❑ Add Remove
a. Pull Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
e. Start Date (mm/dd/yyyy)
c. Employer's Name/Specific Field
f. End Date (mm/dd/yyyy)
g. Rate
1b. Security Pledged
It. Original Loan Amount
J. Remaining Loan Balance
%
$
$
. Full Name of Lending Institution
1. Loan Number
JUL
3. Lender Information ❑ Add ❑ Remove
a. Dill Name, Mailing Address & Phone
(include city, state, & zip)
b. Job TYae/Profession
d. Comments
Union C?
e. Start Date (mm/d ityyyy)
c. Employer's Name/Specific Field
L End Date (mrn/dd/yyyy)
g. Rate
1h. Security Pledged It.
Original Loan Amount
J. Remaining Loan Balance
%
$
$
k. Fall Name of Lending institution
1. Loan Number
4. Total only this Page
$
S. Total of ALL CRO -1430 Pages
(This line mast be on line 21 of Detailed Summary Page CRO -1100)
$
CRO -1430 NC State Board of Elections December 2007