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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