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James, Angelia_2021-PreElection-AmendAmendment Disclosure Report Cover 1 0 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. 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 10-25-21 e. Phone Number 704-320-7650 2. Report Year 3. Period Start Date (mm/dd/yy) 4. Period End Date 5. Treasurer Full Name mmtdd/ Angelia James 2021 09-22-2021 10-18-2021 6. Type of Committee (Check One) 9. Type of Report check only onme type of report ora one category) N Candidate Campaign ❑ Parry Municipal State/County Referendum ❑ PAC ❑ Referendum ❑ Organizational ❑ Organvational ❑ Organizational Independent E] Expenditure E] Joint Fundraiser ❑ five da Thirty-five Y Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ N Pre-primary Pre-election ❑ First ❑ Second ❑ Final ❑ Supplemental Final 7. Type of Fund (iJapplicable, check ore) ❑ "Booster Fund" ❑ Building Fond ❑ Pre -runoff ❑ Third ❑ Annual Semi-annual ❑ Fourth ❑ Special ❑ Mid Yew Semi-annual ❑ Other: ❑ Yew End ❑ Mid Yew 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 Citizens UNION COUNTY 0. Purpose c. Account Code B,ttr*QN FINANCE c. Account Code All Campaign Expenses ° 1 0 C T Mli" 2021 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 I have been trained by thState oard f ections. Angelia James t j 10-29-2021 Printed Name of Signer Signature of ApjVnted Treasurer Date FOR OFFICE USE ONLY Date Received: -0 Employee:QAe Delivery Method ❑ Normal Mail Date Postmarked: Employee: Registered Mail Hand Delivered Date Scanned:�� Employee: ❑ Electronically Filed ❑ 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 -21 00A -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 reporting forms and to total monetary information. 1. Committee Full Name and Fund if applicable) 2. Type of Report 3. ID Number Committee to Elect Angelia James Pre -Election GJMBDF Start of Election Cycle: January 1,2020 Total this Reporting Period Total this Election Cycle 4) Cash on Hand at Start $ 871.68 $ 871.68 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 -1220) (CRO -1230) (CRO -1410) (CRO -1240) (CRO -1250) (CRO -1250) (CRO -1250) (CRO -1170) (CRO -1265) $ $ $ 2700.00 $ 5471.01 $ 200.00 $ 200.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12) TOTAL RECEIPTS (Add lines 5.6, 7,8,9, 10, Ila, IIb,11c,11dand lie) $ 2900.00 $ 5671.01 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) (CRa1310) (CRO -1310) (CRO -1315) (CRO -1420) (CRO -1320) (CRO -1510) $ $ $ $ $ 2530.70 $ 4409.02 $ $ $ $ $ $ $ 500.00 $ 521.01 18) TOTAL EXPENDITURES (Add Ones 13a, 136, 13c, 14. 15, 16and 17) $ 3030.70 $ 4930.03 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18) $ 740.98 j $ 740.98 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 -1670) (CRO -1620) (CRO -1720) (CRO -1710) (CRO -1440) (CRO -2120) (CBD -1215) $ i $ AA -1{ AIGN FINANCE $ OCT 3 0 2021 $ $ RECEIVEEE $ $ $ $ $ $ $ $ CR0.1100 NC State Board of Elections August 2009 Amendment Contributions from Individuals Pg t of 1 ® 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/Profession d. Comments Broker Venkat Sakhamuri 10010 Allyson Park Dr Charlotte, NC 28277 704-659-3730 c. Employer's Name/Specific Field Sona Reality e. Election Sum to Date $ 2000.00 I. Prior g. Account Code It. Form of Payment 1. In -Kind Description j. Date (mmtddtyyyy) k Amount ❑ 01 check 10-05-2021 $ 2000.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Titie/Profession d. Comments Accountant Angelia James PO BOX 2596 Monroe, NC 28111 704-320-7650 c. Employer's Name/Specific Field Angelia's Accounting Services e. Election Sum to Date $ 521.01 f. Prior g. Account Code It. Form of Payment I. In -Kind Description I. Date (mmtddtyyyy) h. Amount ❑ 01 create website 9-22-2021 $ 500.00 ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & rip) b. Job Tille/Prol'ession d. Comments Information Analyst pec (�iaployer'e Name/S t6c Field PNC IV Satish Vankeneni 8027 Tottenham Dr UNION COU Harrisburg, NC 28075 CAMP AIGN FIN 954-668-7284 OCT 3 e. Election Sum to Date $ 200.00 f. Prior g. Account Code h. Form of Pa3KjL%_ I 1:1hNiand Description j. Date (mm/dd/yyyy) b. Amount ❑ 01 check 10-18-2021 $ 200.00 ❑ $ ❑ $ 4. Total only this Page $ 2700.00 5. Total of ALL CRO -1210 Pages $ 2700.00 (Thtr Ane must be on Une 6 oJDeauled Summary Page CRO -1100) CRO -1210 NC State Board of Elections April 2007 Amendment Contributions from Political Party Committees Pg 1 of I ves ❑ No Use this form to report contributions from a political party 1. Committee Full Name and Fund if applicable) 2. ID Number Committee to Elect Angelia James GTIvfBDF 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & rip) b. Comments Democratic Women of Union County 7905 Tottenham Ct Waxhaw, NC 28173 704-698-2602 c. Election Sum to Date $ 200.00 d. Account Code a Form of Payment E In -Kind Description g. Date mm/dd ) It. Amount 01 check 10-12-2021 $ 200.00 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Comments c. Election Sum to Date $ d. Account Code a Form of Payment E to -Kind Description g• Date mm/dd h. Amount 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (toclude city, state, & zip) QUt`tTY b. Comments CAMPAIGN Ft OCT 3 0 2p21 LVED c. Election Sum to Date $ d. Account Code e. Form of Payment I. In -Kind Description m�d d/ h. Amount $ $ 4. Total only this Page $ 200.00 5. Total of ALL CRO -1220 Pages $ 200.00 (This fine must be on fine 7 ojDetaifed Summary Page CRO -1100) CRO -1220 NC State Board of Elections April 2007 endment In -Kind Contributions Pg t of I V Yes Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund. rise umv- tL t :) it m -Nina i,onmounons were or win De rerunaea wltnm / as s. 1. Committee Full Name (and Fund if applicable) 2. ID Number Committee to Elect Angelia James GTMBDF No a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Contributor c. Comments ❑ ® ❑ ❑ ❑ ❑ Individual Candidate Parry PAC Referendum Other Receipt Source ❑ Angelia James PO Box 2596 Monroe NC 28111 704-320-7650 it. Election Sum to Date $ 521.01 e. Description PAC ❑ f. Date (mm/dd/yyyy) g. Fair Market Amount create website 09-22-201 g. Fair Market Amount $ 500.00 $ $ 3. Contributor Information ❑ Add ❑ Remove b. Type of Contributor ❑ a. Full Name, Mailing Address & Phone (include city, state, & zip) ❑ b. Type of Contributor c. Comments ❑ ❑ ❑ ❑ ❑ ❑ Individual Candidate Party PAC Referendum Other Receipt Source PAC ❑ it. Election Sum to Date $ e. Description E Date (mm/dd/yyyy) g. Fair Market Amount f. Date (mm/d( $ $ $ a. Full Name, Mailing Address & Phone (include city, state, & zip) e. CAMPAIGN PIN"' OCT 3 0 2021 RECEIVED it of ALL CRO -1510 Pages fine must be on fine 17 of Detailed Remove b. Type of Contributor ❑ Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source f. Date (mm/d( c. Comments d. Election Sum to Date $ g. Fair Market Amount $ $ $ $ 500.00 $ 500.00 ,KU -1.)1U NC Stine Board of Elections December 2007 Amendment Disbursements Pg 1 of 8 ® Yes ❑ Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated party expenditures. 1. Committee Full Name and Fund if applicable) 2.1D Number Committee to Elect Angelia James I GJMBDF 3. Type of Disbursement Please use separate CRO -1310 fornu for each type of Disbursement ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information ❑ Add El Remove a. Full Name, Mailing Address & Phone include city, state, &;d b. Coordinated Committee Name d. Comments USPS 101 S Charlotte Ave Monroe, NC 28112 800-275-8777 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 11.60 E Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount L Required Remarks 01 Electronic 1 104-21 $11.60 stamps $ 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments Lowe's 2350 W Roosevelt Blvd Monroe, NC 28110 704-226-1744 a Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: a Election Sum to Date $ 7.43 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks 01 Electronic O 104-21 $7.43 magnets 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments MRH Dezign & Photography UN COON1l 4219 Wolf Pond Rd M 10{GN FINPN4GE Monroe, NC 28112 G A 704-219-1739 00 3 0 2021 V E c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 240.00 L Account Code g. Form of Payme t rpose Code i. Date (mm/dd/yyyy) j. Amount L Required Remarks 01 Electronic O 10-5-21 $160.00 car magnets $ 5. Total only this Pae $ 179.03 6. Total of ALL CRO -1310 Pages (This lisegoes in line 13a ofDetailed Summary Page CRO -1100 if Operating Expenses) $ 2530.70 (This fine goes in line 136 of Detailed Summaq Page CRO -1100 ffComc ib to Candidates/Polidcal Comm) (This line goes in line He of DetailedSunumuy Page CRO -1100 ifCoordinafed Parry Expenditures) 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 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 Amendment Disbursements Pg 2 of 8 ® Yes ❑ No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated party expenditures. 1. Committee Full Name and Fund if applicable) 2. ID Number Committee to Elect Angelia James I GJMBDF 3. Type of Disbursement Please use separate CRO -1310 form for each type of Disbursement ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information Add Lj Remove a. Full Name, Mailing Address & Phone include city,state. & zip) b. Coordinated Committee Name d. Comments Shania Kreationz 1919 Old Lawyers Rd Marshville, NC 28103 704-8904723 c. level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 43.00 L Account Code I g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k Required Remarks 01 Electronic B 10-5-21 $43.00 design postcard 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments Franklin Grille 232 E Franklin Monroe NC 28112 704-774-1154 c. Level Registered (Specify) ❑ Federal ❑ county: ❑ State ® Municipality: e. Election Sum to Date $ 69.97 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/ddlyyyy) j. Amount k Required Remarks 01 Electronic O 10-8-2021 $69.97 food for event $ 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & a b. Coordinated Committee Name d. Comments Office Max UN1 GOU 1030 W Roosevelt BlvdFINAn1GE CAMPAIGN Monroe, NC 28110 704-226-9977 OCC 3 � 20 IVED c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 125.10 L Account Code g. Form of P y cut h. Purpose Code t. Date (mm/dd/yyyy) j. Amount k Required Remarks 01 Electronic B 10-8-2021 $125.10 ballots, flyers 5. Total only this Pae $ 238.07 6. Total of ALL CRO -1310 Pages (This fine goes in line Ba of DetailedSuourrary Page CRO -1100 iif Operating Expenses) $ 2530.70 (This ane goes in fine 13b ofDemifed Summary Page CRO-1100if Comrib to Candidates/Polidcal Comm) (This fine goes in line 13c of Detailed Summary Page CRO-11001if Coordinated Parry 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 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 Amendment Disbursements Pg 3 of 8 ® Yes ❑ No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated party expenditures. 1. Committee Full Name and Fund if applicable) 2. ID Number Committee to Elect An elia James I GJMBDF 3. Type of Disbursement Pleaseuse se arate CR0-1310 forms for each twe of DlsbursemenL ® 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 ICL Heavenly PO Box 2784 Monroe, NC 28111 704-225-1464 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 217.00 E Account Code I g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount it. Required Remarks 01 Electronic O 10-08-2021 $217.00 campagin shirts 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) It. Coordinated Committee Name d. Comments Christina's Customize Designs 1007 Massey St Monroe, NC 28110 980-328-3900 c. Level Registered (Specify) ❑ Federal ❑ county: ❑ State ® Municipality: e. Election Sum to Date $ 40.00 L Account Code g. Form of Payment It. Purpose Code i. Date (mm/dd/yyyy) j. Amount k Required Remarks 01 Electronic B 10-10-2021 $40.00 postcards $ 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments Tamara JonesNTYCE 5906 Coral Ridge Lane UNION GOU CAMPAIGN FINAN Indian Trail, NC 28079 803-603-7517 ��T 3 0 2021 E a Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 60.00 L Account Code g. Form ofPsym t urpose Code t. Date (mm/ddlyyyy) I. Amount k. Required Remarks 01 Electronic O 10-12-2021 $60.00 campaign mask and shirts 5. Total onlythis Pae $ 317.00 6. Total of ALL CRO -1310 Pages (This lingoes in fine 13a of DewiledSummmy Page CRD -1100 iif Operating Expenses) $ 2530.70 (This Rnegoes in Use 13b ojDetailed Su n t ary Page CRO -1100 iifConerib to CandidateslPORtical Comm) (This Rnegoer in fine 13c ojDetaffedSummary Page CRO-11001jCoordinmed Parry Expenditures) 7. Purpose Codes List detailed ex nditure 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 require detailed "planation in required remarks field k) C7f04310 NC State Board of Elections December 2009 Amendment Disbursements Pg 4 of 8 ® Yes ❑ No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated party 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 fornts for each tppe o 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 Walmart 2406 W Roosevelt Blvd Monroe, NC 28110 704-289-5478 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 213.67 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount L Required Remarks 01 Electronic O 10-12-21 $213.67 food, paper pro tent, table even} $ 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & ri b. Coordinated Committee Name d. Comments Zaxby's 2232 W Roosevelt Blvd Monroe, NC 28110 704283-0100 c. Level Registered (Specify) ❑ Federal ❑ county: ❑ State ® Municipality: e. Election Sum to Date $ 21.33 E Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount L Required Remarks 01 Electronic O 10-13-21 $21.33 food for Co vopa lln worker $ 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state,& zip) b. Coordinated Committee Name d. Comments Kash Consignments 545 Morgan Mill RdUNION COUNTY Monroe, 28110 CAMPAIGN FINANCE 980-210-3636 49 OCT 3 0 2021 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 76.20 E Account Code I g. Form of Pay i. Date (mm/ddtyyyy) j. Amount k. Required Remarks 01 Electronic O 10-13-21 $76.20 giveaway bags 5. Total only this Pae $ 311.20 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of DelailedSumnuuy Page CRO -1100 if Operating Expenses) $ 2530.70 (This line goes in line 136 of Detailed Summary Page CRO -1100 iiComrib to Candidales/Poliacal Comm) (This lingoes in line 13c ofDemiled Sunmmry Page CRO -1100 iJCoardinaled Party Expenditures) 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 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 Amendment Disbursements Pg 5 of 8 N Yes ❑ No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated party expenditures. 1. Committee Full Name and Fund if applicable) 2. H) Number Committee to Elect Angelia James I GJMBDF 3. Type of Disbursement Please use separate CR04310 formn for each tvae of Disbursement N 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, & zip) b. Coordinated Committee Name d. Comments The Spot Eatery 1513 Concord Ave Monroe, NC 28110 704-218-2482 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State N Municipality: e. Election Sum to Date $ 288.80 E Account Code g. Form of Payment h. Purpose Code i. Date (mm/ddlyyyy) j. Amount L Required Remarks 01 Electronic O 10-13-21 $288.80 food for event 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone Include city, state, & zip) b. Coordinated Committee Name d. Comments Zaxby 2232 W Roosevelt Blvd Monroe NC 28110 704-283-0100 a Level Registered (Specify) ❑ Federal ❑ County: ❑ State N Municipality: e. Election Sum to Date $ 21.33 L Account Code g. Form of Payment h. Purpose Code i. Date (mm/ddlyyyy) J. Amount It. Required Remarks 01 Electronic O 10-13-2021 $21.33 food for Cwanraye worker $ 4. Payee Information ❑ Add ❑ Remove a. Fall Name, Mailing Address & PhoneUNION include city, state, & zip) Chick Fil A 2592 W Roosevelt Blvd Monroe, NC 28110 704-225-8630 COUNT yb. Coordinated Committee Name qp4q CE OCT 3 p 20 e. Level Registered (Specify) Federal ❑ County o C CEN State N Municipality: flG�! d. Comments e. Election Sum to Date $ 23.44 C Account Code g. Form of Payment h. Purpose Code i. Date (mm/ddlyyyy) j. Amount L Required Remarks 01 Electronic 0 10-15-2021 $23.44 food for co m 9<)A worker 5. Total only this Pae $ $ 333.57 6. Total of ALL CRO -1310 Pages (This line goes in fine 13a of Detailed Summary Page CRO -1100 if Operating F_rpenres) (This line goes in fine 136 of Detailed Sunannuy Page CRO -1100 iiContrib to Candidates/Political Camra) (This line goes in Use lie ofDdailed Summary Page CRO -11001y Coordiamed Parry FVenddures) $ 2530.70 7. Pur ose Codes List detailed expenditure code in .) above A* - Media B* - Printing C* - Fundraising E - Salaries F* - Equipment G - Political Party I - Postage J - Penalties K* - Office Expenses O* - Other * Codes require detailed explanation in required remarks field (k D - To Another Candidate H* - Holding Public Office Expenses Q* - Donation to Legal Expense Fund CRO -1310 NC State Board of Elections December 2009 Amendment Disbursements Pg 6 of 8 ® Yes ❑ No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated party expenditures. 1. Committee Full Name and Fund if applicable) 2. 1757 Number Committee to Elect Angelia James GJMBDF 3. Type of Disbursement Please use separate CR04310 fizm for each type of Disbursement ® Operating Expenses ❑ Contributions to Candidates/Political Commiaees ❑ Coordinated Party Expenditures 4. Payee Information Add M Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments Urban Voiced Media PO Box 3481 Lenoir, NC 28645 704-530-4920 c. Level Registered (specify) ❑ Federal ❑ County: ❑ state ® Municipality: e. Election Sum to Date $ 100.00 E Account Code g. Form of Payment h. Purpose Code 1. Date (mm/dd/yyyy) j. Amount L Required Remarks 01 Electronic A 10-15-21 $100.00 media $ 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, statq & zip) b. Coordinated Committee Name d. Comments Food Lion 250 N MLK Jr Blvd Monroe NC 28112 704-225-006 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 109.06 L Account Code g. Form of Payment h. Purpose Code i. Date (mmtd&yyyy) J. Amount k. Required Remarks 01 Electronic O 10-15-2021 $109.06 fruit and veg tra for event 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments Office Max NO 0330 W Roosevelt Blvd UNION FINANCE Monroe, NC 28110 CAMPAIGNegi 704-226-9977 00 3 2 21 ' E0 c Level Registered stered S (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 148.32 L Account Code g. Form of P y urpose Code i. Date (mWdd/yyyy) j. Amount L Required Remarks 01 Electronic 0 10-15-2021 $148.32 flyers, postcard - cards $ 5. Total only this Pae $ 357.38 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CR0.I100 if Operating Expenses) $ 2530.70 (This line goes in line 13b of Detailed Summary Page CR04100 ifContrib to Candidales/Poliacal Comm) (This fine goes in fine 13c of Detailed Summary Page CRO -1100 if Coordinated Parry 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 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 Amendment Disbursements Pg 7 of 8 N ves ❑ Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated party expenditures. 1. Committee Full Name and Fund if applicable) 2. ID Number Committee to Elect An elia James I GJMBDF 3. Type of Disbursement lease use sevarate CRO -1310 fornu for each type of Disbursement N Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information ❑ Add El Remove a. Full Name, Mailing Address & Phone include city, state & zip) b. Coordinated Committee Name d. Comments East Frank and Superette 209 E Franklin St Monroe, NC 28112 704-776-9451 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State N Municipality: e. Election Sum to Date $ 38.00 f. Account Code g. Form of Payment Is. Purpose Code i. Date (mm/dd/yyyy) j. Amount L Required Remarks 01 Electronic O 10-15-21 $38.00 food, ifiikii,%pti5A Q% worker 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments Palace Restaurant 1000 Lancaster Ave Monroe NC 28112 704-283-1123 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State N Municipality: e. Election Sum to Date $ 22.40 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount L Required Remarks 01 Electronic O 10-22-2021 $22.40 food caMfat9^ worker 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments Shania Kreationz UNTY 1919 Old Lawyers Rd UNIUN N FINAN Marshville, NC 28103 GA(JtPA16 704-890-4723 O 202 OC� L Level Registered(Specify) ❑ Federal ❑ county: ❑ State N Municipality: e. Election Sum to Date $ 254.05 L Account Code g. Form of Payment i. Date (mm/dd/yyyy) j. Amount L Required Remarks 01 Electronic O 10-22-21 $254.05 campagin shirts 5. Total only this Pae $ 314.45 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CR0.1100 firoperming Expenses) (This line goes in line 13b of Detailed Summar' Page CRO -1100 ifcomrib to Candidate.vPolifical Comm) $ 2530.70 (This line goes in fine Be ofDetafiedSummary Page CRO -1100 if Coordinated 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 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 Amendment Disbursements pg $ of g ® Yes ❑ No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated party expenditures. 1. Committee Full Name and Fund if applicable) 2. ID Number Committee to Elect Angelia James GJMBDF 3. Type of Disbursement Please use sevarate 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, & ti b. Coordinated Committee Name it. Comments Christina's Customize Designs 1007 Massey Street Monroe, NC 28110 980-328-3900 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 480.00 C Account Code g. Form of Payment It. Purpose Code i. Date (mm/ddlyyyy) j. Amount L Required Remarks 01 Electronic O 10-22-21 $480.00 button, badges, magnets 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 $ L Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks $ 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & ti b. Coordinated Committee Name d. Comments UNION CAMPAIGN FINANCE OCT 3 0 2021 RECEIVED c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ t Account Code I g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount L Required Remarks $ 5. Total only this Pae $ 480.00 6. Total of ALL CRO -1310 Pages (This 0negoes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Detailed Sumrnmy Page CRO-1100lf Comrib to Candidates/Political Comm) $ 2530.70 (This lingoes in line Be of DetailedSumnsary Page CRO -1100 if Coordinated 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) CRU -1310 NC State Board of Elections December 2009