Helms,Richard_2020-4thQtrDisclosure Report Cover Amendment
DisclosureE3 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 iodate information.
1. Committee Information
. Full Name
6;'40Anille � f/tr_-t .Seems nee
c. ID Number
. Mailing Address (include City, State and Zip Code)
d. Date FBM
/a/-2 /Poo./se4,//"
�tf.g.,t. 169 ceJ /' f' -a d p t 3
e. Phone Number
2. Report Year
3. Period Start Date fn nai 4. Period End Date Inan/ad/ )
5. carer Null Name
6. Type of Committee heck a
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
❑ Second
❑ Third
Fourth
❑ Supplemental Final
❑ Annual
❑ Special
7. Type of Fund (if applicable, check one)
❑ Booster Fund
❑ 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
. Financial Institution Full Name
a. Financial Institution Full Name
1_1)e,115 F� °
. Purpose
c. Account Code
b. Purpo
c. Account Code
01, 717C.1-
�
n11
I
lAN 0 8 2021
d. Period Begin Balance
d. Period Begin Balance
G O
CERTIFICATION
I certify that the Committee or Fond 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. 1 further certify that this
report is complete,/we and correct and that I have been trained by the NC State Board
doof,Elections.
Printed Name of Si y Si azure of Ap ointM Treasury Dale
FOR OFFICE USE ONLY
Date Received: al '0 9�I Employee: Delivery Method
❑ Normal Mail
Date Postmarked: Employee: Registered Mail
Hand Delivered
Date Scanned: Employee: Electronically Filed
E3 er Date Data Entered: Employee: maanndatory tramdenceived
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.
( RO-1000 NC Stale Board of Elections August 2008
Detailed Summa Amendment
Summary 0 Yes 1] No
Use this form to summarize all disclosure re rtin forms and to total monetary information
1. Committee Full Name (and Fund—ap ab e)
eport
ambeit
a,; /n q
7� /«d AP4,4/.�sN
Start of Election Cycle: January 1,
Total this
Reporting Period
T
Elec
4) Cash on Hand at Start
$ oR 7 -/ , gel
$
RECEIPTS
5) Aggregated Contributions from Individuals (CRO -1205)
6) Contributions from Individuals (CRO -1210)
7) Contributions from Political Party Committees (CRO -1210)
8) Contributions from Other Political Committees (CRO -1230)
9) Loan Proceeds (CRO -1410)
1111 Refunds/Reimbursements to the Committee (CRO -1240)
11) Other Receipt Sources
Ila) Interest on Bank Accounts (CRO -1250)
1lb) Contributions from Not -For -Profit Organizations (CRO -1250)
llc) Outside Sources of Income (CRO.12So)
ltd) Legal Expense Fund - Other Sources (CRO -1270)
lle) Exempt Purchase Price Sales (CRO -1265)
$
$
$
$
$
$
$
S
$
S
$
$
$
S
$
5
$
S
$
ti
$
12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10,11 a,l lb,I1c,I Id and l le)
$
$
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO -1310)
tj
13b) Contributions to Candidates/Poli - NION COUNTY
tpp�WWPc1NWFr3to)
13c) Coordinated Party Expenditures JAN 0 8 N fRO-1310)
14) Aggregated Non -Media Expenditures (CRO -1315)
15) Loan Repayments RECEIVED420)
16) Refunds/Reimbursements from the Committee (CRO -1320)
17) In -Rind Contributions (CRO -1510)
$ 9
$
$
5
$
ti
$
S
$
5
$
ti
$
5
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, l6 and 17)
$
5
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$ a`
S
DDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees (CRO -1330)
i) "Uum sung Lw its (incl. ones from other campaigns) (CRO.1430)
2) Debts and Obligations owed by the Committee (CRO -1610)
23) Debts and CRO -1620)
4) Account Transfers Within the Committee (CRO -1720)
25; :d-sistrative Support (CRO -1710)
6) Forgiven Loans (CRO -1440)
7) 48 -Hour Notice Reports S= (CRO -2220)
8) Contributions to be Refunded (CRO -1215)
$
$ ;?, p 87,c�
$
$
$
$
$
$
$
$
$
$
$
CRO -1100 NC State Board of Elections August 2008
Disbursements Pg _ of Amendrtreal _ ❑ Yes ❑ No
Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political
committees and coordinated oartv exoenditures
1. _Committee FullName( ppFund if applicable)
[n/YIi77�%%C % C.IFc/ A�cli32d /7`e / lir7s !/CL
Number
\3 c13�
3. Type of Disbursement t(-Pllease use separate CRO -1310 forms for each type of Disbursement.)
Operating Ex enses {J Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures
4. Payee Information 0 Add 0 Remove
a. Full Name, Mailing Address & Phone
(include city, state,, & zip))fj
r4e,eZ OD 1-
% 1 f C,� eR �A/
,I„�ie / /➢� J v / C�
h. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
QFederalCounty:
❑ State ❑ Municipality:
e. Election Sum to Date
C Account Code
g. Formof P1ayment
h. Purpose Code
L Date (mm/ddlyyyy)
'. Amount
q? 'q�
k Required Remarks
pci)l7
/D Z,0$
$
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
, ,lee,6oD K
"`A)4/t/
/7.4 (/«
O A,42//'• C
It. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
❑ Federal 13 county:
❑ State ❑ Municipality:
e. Election Sum to Date _ -
$
. Account Code
g. Form of Payment
DGOrt
h. Purpose Code
i. Date Imm/dd/rpcy( li..Amount
,e7Ja02le
Is. Required Remade
Is
1
4. Payee Information ❑ Add ❑ Remove
. Full Name, Mailing Address & Phone
(include city, sW1944p�,W" ''
;At�PAlGtlFiNAI,-. --- --
)AN 0 B 2021
RECEIVED
b. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
Federal County:
❑ State ❑ Municipality:
e.Election Sumto Date
$
. Account Code
g. Form of Payment
h. Purpose Code
i. Date (mmlddlyyyy)
J. Amount
k Required Remarks
5. Total only this Page
$ 99 , y
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses)
(This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm)
(This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Pa Ex end"res)
$
7. Purpose Codes (List detailed expenditure code in (h.) above)
A* - Media B* - Printing C* - Fundraising D - To Another Candidate
E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses
I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* Other
* Codes re uire detailed ex lanation in re uired remarks field k
CRO -1310 SC Sate Board of Elections December 2009
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 Full Name(and Fund if applicable) _
ComnilA, K -o 4?/e4l /dwx-Zlte%nS l,1cc
2 m No,.ba
�2j iA 9 6
3. Lender Information Add 0 Remove
. Full Name, Mailing Address & Phone
(include 1city, state, & zip)) ,/
Ae),G ,v e � .EJ lIe�iYl5,
/a/2- �� S { hl •V 'L
14)e4><LiAcJ �gl-73
It. Job Tide/Profession
AYA?�55/o U rA
d. Comments
- -
e. Start Date (mm/ddlyyyy)
c. Employer's Na peeitic Field
�/eU/e a Coag
L End Date (nnn/dd/yyyy)
g. Rate
h. Security Pledged 11. Original Loan Amount
J. Remaining Loan Ralaace
%
$ S7.
$ X0$7
k. Full Name of Lending Institution
k Loan Number
3. Lender Information ❑ Add C3 Remove
a. Full Name, Mailing Address & Phone
(include city, state, &zip)
�clf�¢c�
It. Job Title/Profession
_.__ -
6011 0913 5/0 A) e
d. Comments
--
e. start Date (mmlddlyyyy)
u Employer's NataelSpetiOe Field
L End Dau (mm/ idift y)
g. Rate
%
h. Security Pledged
I. Original Loan Amount
$ I�) O b O
J. Remaining Loan Balance
$
k. Full Name of Lending Inantntlon
I. Loan Number
3. lender Information E3 Add E3 Remove
it. Full Name, Mailing Address & Phone
I include city, state, & zip)
UNION COUNTY
CAMPAIGN FINANCE
JAN 0 8 2021
RECEIVED
b. Job Titie/Profession
d. Comments
e. Start Date (mmladlyyyy)
C Employer's Name/SperAc Heid
I. End Date (mnJdd/vvvv )
. Rate
h. Security Pledged
1.Origami loan Amount
J. Remaining Loan Balance
k. Full Name of Lending Institution
L Loan Number
4. Total only this Page 5
otal of ALL CRO -1430 Pages ti
F(ThuLlnemust be on line 21 of Detailed Summary Petip, CRO-lltith
CRO -1430 NC State Board of Elutions December 2007