James, Angelia_2021-35DayReportAmendment
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
a to Number
Committee to Elect Angelia James
GTMBDF
b. Mailing Address (include City, State and Zip Code)
d. Date Filed
PO Box 2596, Monroe NC 28111
9-28-21
e. Phone Number
704-320-7650
2. Report Year
3. Period Start Date (mm/dd/yy)
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 type of report
ora one category)
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
❑
Organizational
❑ Organizational
❑ Organizational
Independent ❑ Joint Fundraiser
®
Thirty-five day
Quarterly
❑ Pre -referendum
❑ Expenditure
❑ Legal Expense Fond
❑
❑
Pre-primary
Pre-election
❑ First
❑ Second
❑ Final
❑ Supplemental Final
7. Type of Fund (fapplicahle, check one)
❑ 'Booster Fund"
❑ Building Fond
❑
Pre -runoff
❑ Third
❑ Annual
Semi-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 Name
First CitizensN
COUNTY
b. Purpose
c. Account Code
b. Putq0MPAIGN I
c. Account Code
All Campaign
01
SEP 2 8 2021
Expenses
d. Period Begin Balance
d. Period Begin Balance
RECEIVED
$ 871.68
$
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 1 have been trained
by the NState Bo azd o Elections.
Angelia James
09-28-2021
Printed Name of Signer
Sign re of Aegintcd Treasurer
Date
FOR OFFICE USE ONLY
Delivery Method
Date Received: r7
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 -2100A -E) to make committee changes.
CRO -1000 NC Stale Board of Elections August 2008
Amendment
Detailed Summary ❑ Va No
Use this form to summarize all disclosure reporting forms and to total monetary information.
1. Committee Full Name and Fund if a licable7727.T
of Re ort
3. ID Number
Committee to Elect Angelia James
Organization
GJMBDF
Start of Election Cycle: January 1, 2020
Total this
Reporting Period
Total this
Election 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
116) Contributions from Not -for -Profit Organizations
Ile) Outside Sources of Income
Ild) Legal Expense Fund —Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRa1270)
(CRO -1265)
$
$
$ 2750.00
$
2771.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines 5.6. 7.8.9. 10, Ila, llb, llc. lldand 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 -131S)
(CRO -1420)
(CRO1320)
(CRa1510)
$
$
$
$
$ 1878.32
$
1878.32
$
$
$
$
$
$
$
$
21.01
18) TOTAL EXPENDITURES (Add lines 13a,13b, 13c, 14, 15, 16 and 17)
$
1878.32
$
1899.33
19) Cash on Hand at End (Add tines 4 and 12 together, then sabtractline 18)
$
871.68
$
871.68
ADDITIONAL INFORMATION
20) Non -Monetary Gifts Given to Other Committees (CRO -1330)
21) 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 CommitteeT%C RO.1620)
UNION COUN
24) Account Transfers Within the CommittEgAMPAIGN FINAL*&1720)
25) Administrative Support SEP 2 a 202YCRO-1710)
26) Forgiven Loans 1440)
27) 48 -Hour Notice Reports Sum RECEIV2220)
28) Contributions to be Refunded (CRO -1215)
$
$
$
$
$
$
$
$
S
$
S
$
$
CRO -1100 NC State Board of ElceUons August 2008
Amendment
Contributions from Individuals Pg 1 or 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 Angelis James
GTMBDF
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & tip)
b. Job Tiae(Professioo
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)
L Amount
❑
check
07-05-2021
$ 1500.00
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, suite, &tip)
b. Job Title/Profession
it. Comments
Tech
Pamela Sowell
796 Hickory Nut Circle
Monroe, NC 28110
704-5624949
c. Employer's Name/Specific Field
DMV
e. Election Sum to Date
$ 100.00
I. Prior
g. Account Code
It. Form of Payment
i. In -Kind Description
j. Date (mm/dd/yyyy)
k Amount
❑
check
07-26-2021
$ 100.00
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & rip)
b. Job Title/Profession
d. Comments
Administrative
Tanya Furf
1910 Waxhaw Hwy
Monroe, NC 28112
704-619-9878
c. Employer's Name/Specific Field
The Retail Odyssey Company
a Election Sum to Date
$ 2500.00
I. Prior
g. Account Code
It. Form of Payment L1
j. Date (mm/dd/yyyy)
IL Amount
❑
check J
08-03-2021
$ 1000.00
❑
$
❑
RECEIVED
$
4. Total only this Page $ 2600.00
5. Total of ALL CRO -1210 Pages
$ 2750.00
(This fine must be on line 6 of Delailed Summary Page CR0.1100)
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 ap livable)
2. tD 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/Profession
d. Comments
Senior Vendor Management
Tiffany Dawson
104 Cregan Hill Ct
Tyribe GA 30290
704-287-1509
c. Employer's Name/Specific Field
Guidant Global
e. Election Sum to Date
$ 150.00
E Prior
g. Account Code
b. Form of Payment
i. In -Kind Description
j. Date (mm/dd/yyyy)
k Amount
❑
electronic
$ 150.00
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & tip)
b. Job Title/Profession
d. Comments _
e. Election Sum to Date
c. Employer's Name/Specific Field
L Prior
g. Account Code
h. Form of Payment
i. to -Kind Description
j. Date (mMdd/yyyy)
k Amount
❑
$
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profemion
d. Comments
UNION COUNT
CAMPAIGN FINANCE
SEP 2 8 2021
c. Employer's Name/Specific Field
e. Election Sum to Date
$
E Prior
A. Account Code
At ment
i. In-IGnd Description
j. Date (mm/dd/yyyy)
k Amount
❑
$
❑
$
❑
$
4. Total only this Page $ 150.00
5. Total of ALL CRO -1210 Pages $ 2750.00
(This fine must be on fine 6 ojDelailed Summary Page CRO -1100)
CRO -1210 NC State Board of Flections April 2007
Amendment
Disbursements Pg 1 of 2 ❑ Yes N No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
committees and coordinated Darty expenditures.
1. Committee Fu6 Name and Fund if applicable) 2. ID Number
Committee to Elect An elia James GJMBDF
3. Type of Disbursement Please use separate CRO -1310 form for each type of Disbursement
® Operating Expenses ❑ Contributions to Candidmes/Political Committees ❑ Coordinated Party Expenditures
4. Payee Information 0 Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state, & a
It. 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
f. Account Code
g. Form of Payment
It. Purpose Code
i. Date (mm/ddfyyyy)
j. Amount
L Required Remarks
Electronic
O
08-05-2021
$80,00
car magnet
$
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state, & a
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
f. Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/ddlyyyy)
j. Amount
L Required Remarks
Electronic
O
08-16-2021
$16.01
business cards
$
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state, & zip)
It. Coordinated Committee Name
d. Comments
MRH Dezign & Photography
4219 Wolf Pond Rd
Monroe, NC 28112
704-219-1739
UNION COUNTY
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ state ® Municipality:
e. Election Sum to Date
$ 330.00
f. Account Code
g. Form of P
o
i. Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
Electronic SER
68 2021
08-16-2021
$250.00
Stand up sign
RE EIVE_D $
5. Total only this Pae $ 346.01
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed Summary Page CRO -11001f OperaBng Expenses) $ 1878.32
(This line goes in fine 13b of DetailedSununurry Page CRO-11001fContetb to CandidatesiPoGacal Conon)
(This line goes in ane 13c of Detailed Summary Page CRO -1100 if Coordinated Parry EWenditures)
7. Purpose Codes List detailed expenditure code in .) 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
Amendment
Disbursements Pg 2 of 2 ❑ Yes No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
committees and coordinated Dartv expenditures.
1. Committee Full Name and Fund if applicable)
2. ID Number
Committee to Elect An elia James
GJMBDF
3. Type of Disbursement Please use separate CRO -1310 fonm 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, & a
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
f. Account Code
g. Form of Payment
h. Purpose Code
I. Date (mm/ddlyyyy)
j. Amount
L Required Remarks
Electronic
O
08-16-2021
$500.30
shirts
$
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
$ 632.31
C Account Code
g. Form of Payment
h. Purpose Code
I. Date (mm/ddlyyyy)
j. Amount
L Required Remarks
Electronic
O
08-23-2021
$132.01
shirts
$
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state, & ti
b. Coordinated Committee Name
d. Comments
MRH Dezign & Photography
4219 Wolf Pond Rd
Monroe, NC 28112
704-219-1739 UNION COUNTY
CAMPAIGN FINANCE
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sum to Date
$ 1230.00
f. Account Code
g. Form o m t
Code
I. Date (mm/dd/yyyy)
j. Amount
k Required Remarks
RE_GE
VED
$90000
$
5. Total only this Pae $ 1532.31
6. Total of ALL CRO -1310 Pages
(This lingoes in line 13a of Delailed Summary Page CRO.1100 if Operating Expenses) $ 1878.32
(This lingoes in line 131, of Detailed Summary Page CRO-11001fComrib to CandidaresiPolitical Comm)
(This line goes in line 13c of Detailed Summary Page CRO -11001f Coordinated Party Exyendimres)
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 n* - Holding Public Office Expenses
I - 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