James, Angelia_2021-Year-endAmendment
Disclosure Report Cover I ❑ zea ® 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. Fall Name
c. m Number
Committee to Elect An elia James
GTMBDF
b. Mailing Address (include City, State and 7Jp Code)
d. Date Filed
PO Box 2596, Monroe NC 28111
I-3-22
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
10-19-2021
12-31-2021
6. Type of Committee (Check One)
9. Type
of Report (check only one toype of repo
ons one category)
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
Ty
Organizational
❑ Organizational
❑ Organizational
Independent ❑ Joint Fundraiser
❑
Thirty-five day
Quarterly
❑ Pre -referendum
❑ Expenditure
❑ Eegal Expense Fund
❑
❑
Pre-primary
Pre-election
❑ First
❑ Second
❑ Final
❑ Supplemental Final
7. Type of Fund (ifapplicable. check one)
❑ "Booster Fund"
❑ Building Fund
❑
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 Citizens
b. Purpose
e. Account Code
b. Purpose
c. Account Code
All Campaign
UNION COUNTY
Expenses
01
CAMPAIGN FINANCE
d. Period Begin Bolan"
d. Period Begin Balance
JAN p 6 2022
$ 740.98
$
CERTIFICATION
I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B, & 2213-22M 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 N late B ard o lections.
Angelia James
1-3-2022
Printed Name of Signer
Signdt&e of Appo' ed Treasurer
Date
FOR OFFICE USE ONLY
a
Delivery Method
Date Received: �O
Employee:
❑ Normal Mail
Registered Mail
Date Postmarked:
Employee: �un�j
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-21o0A-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 reoortine forms and to total monetary information.
1. Committee Full Name and Fund if ap licable 2. Type
of Report
3. m Number
Committee to Elect Angelia James Year End
GJMBDF
Start of Election Cycle: January 1, 2020
Total this
Reportinm Period
Total this
Election Cycle
4)
Cash on Hand at Start
$
740.98
$
740.98
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
lib) Contributions from Not -for -Profit Organizations
Ile) Outside Sources of Income
l ld) Legal Expense Fund —Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1105)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
$
$
$ 100.00
$
5571.01
$
$
200.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
12)
TOTAL RECEIPTS (Addlines5.6, 7.8, 9, 10, Ila,11b, Ile, 11dandIle)
$
100.00
$
5771.01
EXPENDITURES
13) Disbursements
13a) Operating Expenditures
13b) Contributions to Candidates/Podtical 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 -610)
(CRO -1310)
(CRO -1315)
(CRO -1420)
(CRO -620)
(CRO -1510)
$
$
$
$
$ 319.97
$
4728.99
$
$
$
$
$ 521.01
$
521.01
$
$
521.01
18)
TOTAL EXPENDITURES (Add lines Iia, 13b, 13c, 14, 15. 16 and 17)
$
840.98
$
5771.01
19)
Cash on Hand at End (Add lines 4 and 12 together, then subtract tine 18)
$
0.00
$
0.00
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 Commi"ON COUN19Ro"1610)
24) Account Transfers Within the Committ&AIGN FINA�&&1720)
25) Administrative Support JAN 06 2020CRa1710)
26) Forgiven Loans R E C E I V , 21440)
27) 48 -Hour Notice Reports Sum ( 2220)
28) Contributions to be Refunded (CRO -1215)
$
$
$
$
$
$
$
$
$
$
$
$
$
CRD -1100 NC State Board of Elections August 2Ws
Amendment
Contributions from Individuals Pg I of I ❑ Yea ® Na
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) -72-11—D
Number
Committee to Elect Angelis James
GTMBDF
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & tip)
b. Job TitklProfmion
d. Comments
Pastor
Kenneth Belk
3005 Tiffany Dr
Monroe, NC 28110
c. Employer's Name/Specific Field
Minister
e. Election Sum to Date
$ 100.00
I. Prior
g. Account Code
It. Form of Payment
I. In -Kind Description
j. Date (mm/ddlyyyy)
L Amount
❑
01
check
11-01-2021
$ 100.00
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Fall Name, Mailing Address & Phone
(include city, state, & tip)
b. Job Tiae/Profession
d. Comments
c. Employer's Name/Specific Field
e. Election Sum to Date
$
f. Prior
a. Account Code
h. Form of Payment
I. In -Kind Description
j. Date (mm/dd/yyyy)
k Amount
❑
$
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & tip)
b. Job Title/Profession
d. Comments
UNION COUNTY
CAMPAIGN FINANCE
JAN 0 6 2022
c. Employer's Name/Specific Field
e. Election Sum to Date
$
f. Prior
g. Account C
t
I. In -Kind Description
j. Date (mm/dd/yyyy)
K Amount
❑
$
4. Total only this Page $ 100.00
5. Total of ALL CRO -1210 Pages $ 100.00
(Thins Rae muni be on Rae 6 oJDdaW &mmwy Page CRO -1100)
CRO -1210 NC State Board of Elections April 2007
Amendment
Disbursements Pg 1 of 2 ❑ Yes ® No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
miftppc unrt rnnreiinntr_ri narty Pvrwndihmec
1. Committee Full Name and Fund if applicable) 2. ID Number
Committee to Elect An elia James GJMBDF
3. Type of Disbursement Please use se grate CRO -1310 onus or each 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
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
$ 76.22
E Account Code I
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
k Required Remarks
01
Electronic
B
10-23-21
$76,22
postcards
�n
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state, & ti
b. Coordinated Committee Name
d. Comments
Office Max
1030 W Roosevelt Blvd UNION COUNTY
Monroe NC 28110 CAMPAIGN FINANG
704-226-9977 JAN p 6 2022
c. level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sum to Date
$ 128.41
L Account Code
g. Form ofPaym , P B.p o -'
I. Date (mm/dd/yyyy)
j. Amount
k Required Remarks
01
Electronic B
10-27-2021
$128,41
flyers and
ballots campuu
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state, & zip)
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
$ 39.45
f. Account Code
g. Form of Payment
h. Purpose Code
1. Date (mm/ddlyyyy)
j. Amount
Is. Required Remarks
01
Electronic
B
10-29-2021
$39.45
campaign
postcards
$
5. Total only this Pae $ 244.08
6. Total of ALL CRO -1310 Pages
(This ane goes in line 13a of DetailedSummary Page CRO -1100 if Operating Expenses) $ 319.97
(This line goes in line 136 of Detailed Summary Page CRO -1100 if Comrib to CandidateslPolitical Comm)
(This ane goer in line 13c of DetalledSumunivy, Page CRO -1100 if Coordinated Parry Expenditures)
7. Pur ose 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 2(M
Amendment
Disbursements Pg 2 of ❑ Yes ® No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
committees and coordinated Darty expenditures.
1. Committee Full Name and Fund ifapplicable)
2. ID Number
Committee to Elect An elia lames
GJMBDF
3. Type of Disbursement Please use separate CRO -1310 forrm for each type of Disbursement
® Operating Expenses ❑ Contributions to Candidates/Political Committees C] Coordinated Party Expenditures
4. Payee Information Ll Add Remove
a. Full Name, Mailing Address & Phone
include city, state, & a
b. Coordinated Committee Name
d. Comments
Alice Jules Coffeehouse
204 Lancaster Ave Apt I
Monroe, NC 28112
704-292-7777
c. Level Registered (Specify)
❑ Federal ❑ County
❑ State ® Municipality:
e. Election Sum to Date
$ 14.98
E Account Code
g. Form of Payment
It. Purpose Code
i. [late (mm/ddlyyyy)
j. Amount
L Required Remarks
01
Electronic
O
11-2-21
$14.98
coffee, snacks
camp ign workers
4. Payee Information ❑ Add ❑ Remove
s. Full Name, Mailing Address & Phone
include city, state, & zip)
b. Coordinated Committee Name
d. Comments
Food Lion
250 N MLK Jr Blvd UNION COUNTY
Monroe NC 28112 CANIPAI(iN FINANCE.
704-225-0036 AN p 6 2022
c. Level Registered (Specify)
❑ Federal ❑ county:
❑ State ® Municipality:
e. Election Sum to Date
$ 13.58
f. Account Code
g. Form of Paym
i. Date (mm/ddlyyyy)
j. Amount
L Required Remarks
01
Electronic O
11-2-2021
$13.58
drinks for
campaign workew
$
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state. & a
b. Coordinated Committee Name
d. Comments
Smoke Pit
1507 W Roosevelt Blvd
Monroe, NC 28110
704-289-7427
c. Level Registered (specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sum to Date
$ 47.33
L Account Code
g. Form of Payment
h. Purpose Code
i. Date (mmlddlyyyy)
j. Amount
L Required Remarks
01
Electronic
O
11-2-2021
$47.33
food for
campaign workers
$
5. Total only this Pae $ 75.89
6. Total of ALL CRO -1310 Pages
(This ane goes in ane 13a of Detailed Summu!v Page CRO -1100 if Operating Expenses) $ 319.97
(This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to CandidalmlPoli6eal Comm)
(This finegoes in fife 13e of Detailed Summary Page CR0.11001fCoordinated Party Eayenditures)
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 2[109
Amendment
Refunds/Reimbursements From the Committee Pg , of I ❑ ves ® No
Use this form to report refunds/reimbursements, including contributions returned to the contributor.
1. Committee Full Name (and Fund if applicable) 2. ID Number
Committee to Elect Angelia James GJMBDF
3. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & rip)
d. Type of Committee
h. Original Receipt Date
Candidate PAC
Referendum Parry
7-02-21
Angelia James
A) bav
r %'Avo.�C 2-$ I11
tvy 32o ifih-❑
e. Level Registered (Specify)
I. Original Receipt Amount
Federal 0 County:
State ® Municipality:
$ 521.01
E Purpose Code
j. Election Sum to Date
p
$ 521.01
b. Job Title/Profession
e. Employer's Name/Specific Field
g. Comments
k. Account Code
Accountant
Angelia's Accounting
Services Inc
reimbursement create webs
filing fee and busi cards
01
I. Form of Payment m. Required Remarks I
o. Date (mm/ddlyyyy)
o. Amount
check reimiurFer.t^ Cretff s.te-ai( 4nd I,F'+j ff d IxJ'--ts
d
11-0-21
$ 521.01
3. Payee Information E) Add E] Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
d. Type of Committee
h. Original Receipt Date
Lj Candidate Lj PAC
Referendum Ej Party
e. Level Registered (Specify)
L Original Receipt Amount
El Federal El County:
❑ State ❑ Municipality:
$
L Purpose Code
j. Election Sum to Date
h.Joh Title/Profession c. Emplocer's Name/Specific Field
g. Comments
LAccount Code
I. form of Pay mens
m. Required Remarks
a. Date (mm/dd/yyyy)
o. Amount
$
3. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
d. Type of Committee
h. Original Receipt Date
Candidate 0 PAC
Referendum Party
UNION Ct)'
CAMPAIGN FIN rVCE
HN U L
IAN
1
RECEIVEDE
e. Level Registered (Specify)
I. Original Receipt Amount
Federal County:
❑ State ❑ Municipality:
$
Purpose Code
j$Election Sum to Date
b. Job Title/Profession
c. Employer's Name/Specific Field
g. Comments
lc Account Code
I. Form of Payment
m. Required Remarks
n. Date(mm/dd/yyyy)
It. Amount
$
4. Total only this Page $ -4-,z1. 0�
5. Total of ALL CRO -1320 Pages (This fine must be online 16 of Derailed Summary Page CRO -1100) $ !;a 1 • a
L - Returned to Contributor M - Overpayment for Service N - Exceeded Contribution Limit
P• - Reimbursement of In -Kind O. Other
• Codes require detailed explanation in required remarks field m
CRO -1320 NC State Bound of Elections December 2007