James, Angelia_2021-35DayReport-amendAmendment
Disclosure Report Cover I ® 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 update information
1. Committee Information
a. Full Name
c. ID Number
Committee to Elect An elia James
GTMBDF
b. Ma(ling Address (include City, State and Zip Code)
d. Date Fled
PO Box 2596, Monroe NC 28111
9-28-2I
e. Phone Number
704-320-7650
2. Report Year
3. Period Start Date (mm/ddyy)
4. Period End Date
5. Treasurer Full Name
(mm/dd/yy)
Angelia James
2021
07-04-2021
09-21-2021
6. Type of Committee (Check One)
9. Type
of Report (check only one e of report
om one cate o
® Candidate Campaign ❑ Party
Municipal
State/Couty
Referendum
❑ PAC ❑ Referendum
❑
Organizational
❑ Organizational
❑ Organizational
Independent ❑ Joint Fundraiser
❑ Expenditure
®
Thirty-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑
❑
Pre-primary
Pre-election
❑ First
❑ Second
❑ Final
❑ Supplemental Final
7. Type of Fund (ifapplicahle, check one)
❑ 'Booster Fund"
❑ Building Fond
❑
Pre -runoff ❑
Third
❑ Annual
Simi -annual
❑ Fourth
❑ Special
❑
Mid Year
Semi-annual
❑ Other:
❑
Year End
❑ Mid Year
10. Special Report Name
❑
❑
Final
special
❑ Year End
❑ Final
❑ Special
8. Number of Fundraisers this Report
0
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Na
First Citizens
b. Purpose
c. Account Code
b. Purpose
Code
All Campaign
01
ExpensesREC
it. Period Begin Balance
e ' to Balance
$ 0
$
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 in isclosed funds. 1
further certify that this report
is complete, true and correct and that 1 have been trained
by the Ntate Boar, of lecti
Angelia James
09-28-2021
Printed Name of Signer
Signm of Appoin reasurer
Date
FOR OFFICE USE ONLY
Delivery Method
Date Received:
Employee:
❑ Normal Mail
Registered Mail
Date Postmarked:
Employee:
Hand Delivered
Electronically Filed
Date Scanned:
Employee:
❑ Signer has not received
mandatory training
Date Data Entered:
Employee:
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 revortinp forms and to total monetary information.
1. Committee Full Name and Fund if applicable)
12. Type
of Report
3. ID Number
Committee to Elect Angelis James
35 Day
GJMBDF
Start of Election Cycle: January 1, 2020
Total
riod
Reporting Period
Total this
EleMion Cycle
4) Cash on Hand at Start
$
0
$ 0
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
11b) Contributions from Not -for -Profit Organizations
Ile) Outside Sources of Income
11d) Legal Expense Fund—Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1120)
(CRO -1230)
(CRQ1410)
(CRO -1240)
(CRO -1250)
(CRO -1150)
(CRO -1250)
(CRO -1170)
(CR&1265)
$
$
$ 2750.00
$ 2771.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9,10, Ila I1b, 11c, Ildand Ile)
$
2750.00
$ 2771.01
EXPENDITURES
13) Disbursements
13a) Operating Expenditures
13b) Contributions to Candidates/Political Committees
13c) Coordinated Party Expenditures
14) Aggregated Non -Media Expenditures
15) Loan Repayments
16) Refunds/Reimbursements From the Committee
17) In -Kind Contributions
(CRO -1310)
(CRO -1310)
(CRO -1310)
(CRO -1315)
(CRO -1420)
(CR04310)
(CRO -1510)
$
$
$
$
$ 1878.32
$ 1878.32
$
$
$
$
$
$
$
$ 21.01
18) TOTAL EXPENDITURES (Addlims 13a, 13b, I3c. 14,15.16and17)
$
1878.32
$ 1899.33
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18)
$
871.68
$ 871.68
ADDITIONAL INFORMATION
20) Non -Monetary Gifts Given to Other Committees
21) Outstanding Loans (incl. ones from other campaigns)
22) Debts and Obligations owed By the Committee
23) Debts and Obligations owed To the Committee
24) Account Transfers Within the Committee
25) Administrative Support
26) Forgiven Loans
27) 48 -Hour Notice Reports Sum
28) Contributions to be Refunded
(CRO -1330)
(CRO -1430)
(CRO -1610)
(CRO -1620)
(CRO -1720)
(CRO -1710)
(CRO.1440)
(CRO -2220)
(CRO -1115)
$
$
$ r. UAN F
NANGE
$
$
$ RE
$
$
$
$
$
$
CRO -1100 NC State BoW of Elections August 2008
Amendment
Contributions from Individuals Pg I or 2 ® ves ❑ No
Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used
1. Committee Fall Name and Fund if applicable)
2. ID Number
Committee to Elect Angelis James
GTMBDF
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & tip)
b. Job Title/Profession
d. Comments
Administrative
Tanya Furr
1910 Waxhaw Hey
Monroe, NC 28112
704-619-9878
c. Employer's Name/Specific Field
The Retail Odyssey Company
e. Election Sum to Date
$ 1500.00
E Prior
g. Account Code
h. Form of Payment
i. In -Kind Description
j. Date (mm/dd/yyyy)
k Amount
❑
01
check
07-05-2021
$ 1500.00
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & rip)
It. Job Title/Profession
d. Comments
Tech
Pamela Sowell
796 Hickory Nut Circle
Monroe, NC 28110
704-562-4949
c. Employer's Name/Specific Field
DMV
e. Election Sum to Date
$ 100.00
f. Prior
g. Account Code
b. Form of Payment
I. In -Kind Description
j. Date (mm/dd/yyyy)
k Amount
❑
01
check
07-26-2021
$ 100.00
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove .,gPAIGN FINAN
E
a. Full Name, Mailing Address & Phone
(include city, state, &zip)
b. Job Title/Profession
d. Comments
Administrative
SEP 3 U 2021
RECEIVED
Tanya Furr
1910 Waxhaw Hwy
Monroe, NC 28112
704-619-9878
c. Employer's Name/Specific Field
The Retail Odyssey Company
c. Election Sum to Date
$ 2500.00
E Prior
g. Account Code
h. Form of Payment
E to -Kind Description
j. Date (mm/dd/yyyy)
it. Amount
❑
01
check
08-03-2021
$ 1000.00
❑
$
4. Total only this Page $ 2600.00
5. Total of ALL CRO -1210 Pages $ 2750.00
(This fine must beon fine ti of Demifed Summunl Page CRO -1100)
CRO -1210 NC State Board of Elections April 2007
Amendment
Contributions from Individuals Pg 2 of 2 ® Yes ❑ No
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)
2. ID Number
Committee to Elect Angelia James
GTMBDF
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Professlon
d. Comments
Senior Vendor Management
Tiffany Dawson
104 Cregan Hill Ct
Tyribe GA 30290
704-287-1509
c. Employers Name/Specific Field
Guidant Global
e. Election Sum to Date
$ 150.00
f. Prior
g. Account Code
Is. Form of Payment
i. to -Kind Description
j. Date (mm/ddlyyyy)
k Amount
❑
Ol
electronic
$ 150.00
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
c. Employer's Name/Speeific Field
e. Election Sum to Date
$
E Prior
g. Account Code
h. Form of Payment
i. In -Kind Description
j. Date (mmldd/yyyy)
L Amount
❑
$
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Co
SEP 3 0 2021
e.E ae
o Employer's Name/Specific Field
$
I. Prior
g. Account Code
Is. Form of Payment
I. In -Kind Description
j. Date (mm/ddlyyyy)
K Amount
❑
$
❑
$
❑
$
4. Total only this Page $ 150.00
5. Total of ALL CRO -1210 Pages
$ 2750.00
(This fine amst be on Gne 6 ofDeralied Summary Page CRO.1100)
CRO -1210 NC State Board of Elections April 2007
Amendment
Disbursements Pg 1 of 2 DQ Yes ❑ No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
committees and coordinated oartv expenditures.
1. Committee Full Name and Fund if applicable) 2. H) Number
Committee to Elect Angelis James GJMBDF
3. Type of Disbursement Please use separate CRO -1310 forim for each type of Disbursement
® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures
4. Payee Information El Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city,state, & a
b. Coordinated Committee Name
d. Comments
MRH Dezign & Photography
4219 Wolf Pond Rd
Monroe, NC 28112
704-219-1739
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sum to Date
$ 80.00
E Account Code
g. Form of Payment
h. Purpose Code
i. Date (mmlddlyyyy)
j. Amount
k. Required Remarks
01
Electronic
O
08-05-2021
$80,00
car magnet
$
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state, & ri
b. Coordinated Committee Name
d. Comments
Office Max
1030 W Roosevelt Blvd
Monroe, NC 28110
704-226-9977
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sum to Date
$ 16.01
L Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
01
Electronic
B
08-16-2021
$16.01
business cards
4. Payee Information ❑ Add ❑ Remove UNION CO=N
a. Full Name, Mailing Address & Phone
include city, state, & zi
Is. Coordinated Committee Name
OADM
SCP 3 Q 2 21
RECEIVED
MRH Dezign & Photography
4219 Wolf Pond Rd
Monroe, NC 28112
704-219-1739
c. Level Registered (Specify)
❑ Federal L]Count :
❑ State ® Municipality:
e. Election Sum to Date
$ 330.00
L Account Code
g. Form of Payment
h. Purpose Code
L Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
01
Electronic
B
08-16-2021
$250.00
Stand up sign
5. Total only this Pae $ 346.01
6. Total of ALL CRO -1310 Pages
(This line goes in line 13o of Detailed Summary Page CRO -1100 if Operating Expenses) $ 1878.32
(This line goes in line 13b of Detailed Summary Page CRO -11001f Comrib to Candidates/PoGficat Comm)
(This line goes in line 13c of Detailed Summary Page CRO- 1100lf Coordinated Party Fapendltures)
7. Pur ose 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
1 - Postage 3 - Penalties K* - Office Expenses Q* -Donation to Legal Expense Fund
O* - Other
* Codes require detailed explanation in required remarks field k)
CRO -1310 NC State Board of Elections December 2009
Amendment
Disbursements Pg 2 of 2 W Yes ❑ No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
rnmmittees and coordinated nartv exnenditures.
1. Committee Full Name and Fund if a licable 2. ID Number
Committee to Elect Angelis James GIMBDF
3. Type of Disbursement Please use separate CRO -1310 forms for each type of Disbursement
® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state & zip)
b. Coordinated Committee Name
d. Comments
Kraze Custom Prints
2115 W Roosevelt Blvd
Monroe, NC 28110
704-774-1141
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sum to Date
$ 500.30
L Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/ddlyyyy)
j. Amount
k. Required Remarks
0)
Electronic
O
08-16-2021
$500.30
shirts
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state, & A
b. Coordinated Committee Name
it. Comments
Kraze Custom Prints
2115 W Roosevelt Blvd
Monroe, NC 28110
704-774-1141
e. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sum to Date
$ 632.31
f. Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/ddlyyyy)
j. Amount
k. Required Remarks
01
Electronic
O
08-23-2021
$132.01
shirts
4. Payee Information ❑ Add ❑ Remove NCE
a. Full Name, Mailing Address & Phone
include city, state, & zip)
b. Coordinated Committee Name
omments
SEp 3 0 202
RECEIVED
MRH Dezign &Photography
4219 Wolf Pond Rd
Monroe, NC 28112
704-219-1739
c. Level Registered (Specify)
❑ Federal El County:
❑ State ® Municipality:
a Election Sum to Date
$ 1230.00
f. Account Code
g. Form of Payment
Is. Purpose Code
i. Date (mm/dd/yyyy)
J. Amount
k. Required Remarks
01
Electronic
B
08-30-2021
$900.00
campaign signs
5. Total only this Pae $ 1532.31
6. Total of ALL CRO -1310 Pages
(This fine goes in line 13a of Delailed Summary Page CRO-1100lJOperming Erpenaes)
(This line goes in line 13b of DetailedSummauy Page CRO -11001f Contrib to Candidates/Political Comm) $ 1878.32
(This lingoes in fine Mc ojDetailed Summary Page CRO-1100lj(7oordnmed Party Expenditures)
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
1 - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* - Other
* Codes require detailed explanation in required remarks field k
CRO -1310 NC State Board of Elections December 2009