Helms,Richard_2021-Year-endDisclosure Report Cover A❑:3 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 undate information.
1. Committee Information
. Full Name/ ) //
c. ID Number
�
Al/ �t elec zchJave(r
b. Mailing Address (include City, State and ZipCa e)
d. Date Filed
i�/a os - R-
of
( 73
/3.
e. Phant Numiler
2. Report Year
Period Start Date 0um1dd/yy)
4. Perio End ate (nm,tddtyy)
5. Tr urer Full Name
C26 (
? o l aoa i
/a131 aoa.1
,fk ') R{/Ms
6. Type of Committee Check Ono _
9. Type ofReport (check only one type of report from one category)
Candidate Campaign ❑ Party
Municipal
State/County
Referendum
PAC ❑ Referendum
-_
❑ Organizational
❑ Organizational
❑ Organizational
❑ Independent Expenditure ❑ Joint Fundmiser
❑ Thirty-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑ Pre-primary
❑ First
❑ Final
❑ Pre-election
❑ Pre -runoff
❑ Second
❑ Third
❑ Supplemental Final
❑ Annual
7. Type of Fund (+f applicable, check one)
❑ Booster Fund
Semi-annual
❑ Fourth
❑ Special
❑ Building Fund
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
10. Special Report Name.
❑ Other:
❑ Final
❑ Special
Year End
Final
8. Number of Fundraisers this Report
Special
11. Account Information
11. Account Information
a. financial Instittutiioon Full Name
a. Financial Institution Fall Name
.vt X'J 4A O
. Purpose
c. Account Code
b. Purpose
c. Account Code
/
COUN
CAMPAIGN FINAr
Y
IC
t
6 //,/!l/ e
A
A
it. Period Begin Balance ___._.
d. Period Begin Balance
(frs
2022
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.
73. H-1#0!5 S2 , ,t�.ul�,, �
Printed Name of Signer Signature of Appointed Treasurer Date
FOR OFFICE USE ONLY
Date Received: Employee: 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-210OA-E) to make committee changes.
CRO -1000 NC State Board of Elections August 2008
':Amendment
Detailed Summary ❑ Yes ❑ No
Use this form to summarize all disclosure renortinv forms and to total monetary infnrmatinn -
1. Committee Full Name (and Fund if applicable)
2. Type of Report
3. ID Number
Cc.0M�7%.- td P/e�114,a J-#eIms
lCir-/z 2A"O(
93 Vyl q 3Q
Start of Election Cycle: January 1, 06 2 1
Total this
Reporting Period
Total this
Election Cycle
4) Cash on Hand at Start
$ c/, O 6
$
RECEIPTS
5) Aggregated Contributions from Individuals (CRO -1205) $
6) Contributions from Individuals (CRO -1210) $
7) Contributions from Political Party Committees (CRO -1220) $
8) Contributions from Other Political Committees (CRO -1230) $
9) Loan Proceeds (CRO -1410) $
10) Refunds/Reimbursements to the Committee (CRO -1240) $
11) Other Receipt Sources
lla) Interest on Bank Accounts (CRO -1250) $
llb) Contributions from Not -For -Profit Organizations (CRO -1250) $
Ile) Outside Sources of Income (CRO -1250) $
1Id) Legal Expense Fund -Other Sources (CRO -1270) $
Ile) Exempt Purchase Price Sales (CRO -1265) $
$
$
$
$
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9,10,1 la,1 lb,I lc,l Id and l le) $
$
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO -1310) $
13b) Contributions to Candidates/Political Committees (CR0.1310) $ 10 (o &4, p
13c) Coordinated Party Expenditures (CRO -1310) $
14) Aggregated Non -Media Expenditures (CRO -1315) $
15) Loan Repayments (CRO.1420) $
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 `y 0 6
$
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line I8 $ p
$
ADDITIONAL INFORMATION
20) Non -Monetary Gifts Given to Other Committees (CRO -1330)
1) Outstanding Loans (incl. ones from other campaigns) (CRO -1430)
22) Debts and Obligations owed by the Committee (CRO -1610)
23) Debts and Obligations owed to the Committee (CRO -1620)
UNION COUNTY
24) Account Transfers Within the CommiltPAIG_ N FIN,@LI72o)
5) Administrative Supportcaoano)
- ---- JAN 18 ?p J
26) Forgiven Loans CRO -1440)
7) 48 -Hour Notice Reports Sum R I_ ( 20)
28) Contributions to be Refunded (CRO -1215)
$
$
$
$
$
$ $
$ $
$ $
$ $
CRU -1100 NC State Board of Elections August 2008
Amendment
Disbursements Pg _ of ❑ Yes ❑ No
Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political
cnmmittrec and rnnrdinated .arty ernendihuees
1. Committee Full Name (and Fund if applicable) 2. ID Number
Go'm*fre,-e toele-.+- ZIC- e"&A ge.(mS UC..e- SVA qa4
3. Type of Disbursement Please use separate CRO -1310 orms or each type o DiSbul'u"ement. I e
Operating Expenses Contributions to Candi dates/Political Committees I Cnnrclinnmerl P.'Ie Pxnendinirec 1
4. Payee Information ❑ Add �J Remove
a. Full Name, Mailing Address & Phone
(include city, state, & Alt)
ZJ a >o 104 N C- a a 113
b. Coordinated Committee Name
d. Comments
n Level Registered (Specify)
0 Federal County:
❑ State ❑ Municipality:
e. Election Sum to Date
f. Account Code
Ig. Form of Payment
eek
h. Purpose Code
i. Date (mmlddlyyyy) j. Amount
aayi lo��t.b�
k. Required Remar
C1
Is
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality:
e. Election Sum to Date
. Account Code
g. Form of Payment.
h. Purpose Cade
i. Date.(mm/dd/yyyy)
j. Amount
1k. Required Remarks
$
$
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Coordinated Committee Name
d. Comments
UNION COUNTY
CAMPAIGN FINANCE
JAN 18 2022
c. Level Registered (Specify)
Federal 13 County:
❑ State ❑ Municipality:
e. Election Sum to Date
f, Account Code
g. or of Payment
h. Purpose Code
i. Date (mmlddlyyyy)
J. Amount
it. Required Remarks
$
5. Total only this Page $
Total of ALL CRO -1310 r -ages
i
(This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) j C
(This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to CandidaleslPolitical Comm) i
(This line goes in line 13c of pelailed Stonnra.y A.o,..^ ^.:: L.::. • " _
7. Purpose Codes (List detailed expe
A* MZZ!:.. Au A- • .-
E - Salaries F* - Equipment
I - Postage J - Penalties
code in (h) above)
C* F andrajsing
G - Political Party
K* - Office Expenses
O* Other
-- -
a,1Cv-i S10 NC Slate Board of Elections
D - To Another Candidate
H* - Holding Public Office Expenses
Q* - Donation to Legal Expense Fund