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Kamolnik,Colleen_2022-1st-qtrAmendment Disclosure Report Cover ❑ YesNa Use this form for general report and committee information, mus be sig 'edran� sublin d al g with other detailed orms. Do not use tins toren to uPaale mrormauoa Nile 1. Committee Information Full Name c. ID Number CoIlee ofnik- NY &C Dlstvlcf . Mailing Address (include City, State and Zip Code) _ _ - Date Filed —121 A, yc h' i1 t bi 0 505 2022- e. Phone Number M O l7 h1t C 2_'W I I Z IM 2qu 4 %4 . Report Year 3. Period Start Date (mmtdd/yy) 4. Period End Date (mm/dd/yy) 5. Treasurer Fall Name 2022 2 oq�3o oz2 OI DI 202 z ColleeilmcFmdCLOM14- • Type of Committee (Check One) 9. Type of Report (check only one type of report from one category) Candidate Campaign ElParty ❑ PAC ❑ Referendum Municipal ❑ Organizational State/County ❑ Organizational Referendum ❑ Organizational ❑ Independent Expenditure ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fund UPre-Primary first ❑ Final ❑ Pre-election ❑ Pre -runoff ❑ Second ❑ Third ❑ Fourth ❑ Supplemental Final ❑ Annual ❑ Special . Type of Fund ({% — ficable, check one) ❑ Booster Fund Semi-annual ❑ Building Fund ❑ Mid Year ❑ Year End Semi-annual ❑ Mid Year 10. Special Report Name ❑ Other ❑ Final ❑ Special [3 Year End ❑ Final . Number of Fundraisers this Report ❑ Special 11. Account Information 11. Account Information a. Financial Institution Full Name UNION COUNTY Financial Institution Full Name {� Wmerican RArlk +h1P'nj . Purpose c. Account Code b. Purpose MAY c. ArtbOW Code ( 0 5 022 r7 Carnplyvl4inding RECE� G CD d. Period Begin Balance Period Begin Balance $ �. 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 ]have been a ate Boardlection. Callan m("c4 0> ns 2ea'3 ate Printed Name of Sign" Si ature of A poimed Treasurer FOR OFFICE USE ONLY �1 Delivery Method Date Received: C Employee: ❑ Normal Mail ❑ Registered Mail Date Postmarked: Employee: Z, Hand Delivered [3 Electronically Filed to Date Scanned: Employee: y ❑ Signer has not received Date Data Entered: Employee: mandatory training 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. ..,...--.- o -- _r n-..«.,.,. August 2IXI13 CRO -1000 Detailed Summary Amendment ❑ Yes 2!LNo 1. a.nm.U=rO ".k ....-........ _�— — — —. �-- — --— - - -- alwn hmo1n1 � NY astv�cf I 2 Total this Total this Start of Election Cycle: January 1> C Reporting Period Election Cycle 4) Cash on Hand at Start $ 0 Is O 5) Aggregated Contributions from Individuals (CRO -1205) 6) Contributions from Individuals (CRO -1210) 7) Contributions from Political Party Committees (CRO -1220) 8) Contributions from Other Political Committees (CRO.1230) 9) Loan Proceeds (CRO -1410) 10) Refunds/Reimbursements to the Committee (CRO -1240) 11) Other Receipt Sources Ila) Interest on Bank Accounts (CRO -1250) llb) Contributions from Not -For -Profit Organizations (CRO -1250) Ile) Outside Sources of Income (CRO -1250) 11d) Legal Expense Fund - Other Sources (CRO -1270) Ile) Exempt Purchase Price Sales (CRO- 1265) $ $ $ 10.4 OD $ I q.)9100 $ $ $ $ $ $ $ $ rZ�oS-�3 $ $ $ $ $ $ $ $ $ $ $ 12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9,10,1la,l lb,l lc,11d and Ile) $ $ 13) Disbursements 13a) Operating Expenditures (CRO -]370) 13b) Contributions to Candidates/Political Committees (CRO -1310) 13c) Coordinated Party Expenditures / (CRO -1310) 14) Aggregated Non -Media Expenditures (CRO -1315) 15) Loan Repayments (CRO -1420) 16) Refunds/Reimbursements from the Committee (CRO -1320) 17) In -Kind Contributions (CRO -1510) $ I y 21 . 1 $ $ $ $ $ a1 (6.'-73 $ $ rZ�oS-�3 $ $ $ $ 2q , 0 $ 2-q • bfl 18) TOTAL EXPENDITURES (Add lines 13s, 13b, 13c, 14, 15, 16 and 17) 19) Cash on Hand at End (Add lines 4 and 12 together, dim subtract line 18 $ $ (-1) 22. 1 0 2L 0 (P • GiD $ $ 2 ()(O ' Q Non -Monetary Gifts Given to Other Committees (CRO -1330) $ Outstanding Loans (incl. ones from other campaigns) (CRO -1430) $ Debts and Obligations owed by the Committee �g0.1610) $ g UNUtI i OUNfY Debts and Obligations owed to the Coolditfek3N FINAN"1620) $ Account Transfers Within the Committ RO.1720) $ 1AY 0 5 202T- s Administrative Support (CRO -Z710) $ Forgiven Loans R E C E I V Ep1440) $$ 48 -Hour Notice Reports Sum (CRO -2220) $ $ Contributions to be Refunded (CRO -1215) $ $ Contributions from Individuals Amendment El "as� Pg of ` El yes dNo �..> cutw w ropurt murvtuum conntounons over lou or contributions under $50 if form CRO 1205 is not used 1. Committee Full Name (aud -Fund aPL ). _2 ID Number _ Co ►Ic,(,v, VA M O hn - fti (Bo sfo (f I _. 3. Contributor Information �. ;, Add ❑ Remove a. Foil Name, Meiling Address & Phone b. Job d. Comments ``(include city, staate�&�yzip) ,,Title/Profession Clflle rQl�-CuV C. Employer's Name/Specific Field SeI!`T riew1 erA, NC 2?5(oo e. Election Sum to Date $ 50,00 . Prior g. Account Code h. Form of Payment L to -Kind Description _-_ J. Date (m ildd/yyyy) k Amount ❑ I onlln1p, 212512-0u $ 5o,vo ❑ $ ❑ $ 3. Contributor Information AVO Add ❑ Remove . Full Name, Mailing Address & Phone b. Job TidelProfession d. COmmsd N C O U N 1 Y (include city, state,&zip) -- Ret�r�d CAMPAIGN FINi+VC - 9Pa1Ylc,kp mcgnde, c, Employer's Name/Spedfic Field 114 Ot h lee nY MAY 0 5 2022 Hollywood, S6 2944q N 1p e.El E $ 100-01) . Prior g. Account Code h. Form of Payment IL In -Kind Description '. Date (mm(dd/yyyy) It. Amount ❑ I c,hec-k 412.512- $ loo,o ❑ $ 1❑ $ . conmouior fmormanon �W Add ❑ Remove . Fall Name. Mailing Address & Phone b. Job Tide/Profession d. Comments (include city, state, &zip) En v I ron fhenfv ( D(sl n N o yes Haman a Employer's Name/SpeciDc Field 5uo1 Col ruin R ickv 0r --- - I h di un 7VUi 1, NC 2 Bo-Iq wildlanks Njineenny e. Election Sum to Date $ 150. oo . Prior, g. Account Code It. Form of Payment L In -Kind Description - J. Date (mm/dd/yyyy) it. Amount ❑ Online- 03ItpI20272- $ ISO.OC, ❑ $ ❑ $ 4. Total only this Page " $ 300.0 O S. Total of ALL CRO -1210 Pages I Q /� Mir Has a ua be ox tine 6 efDWaardSmnwy Page CRO -1180) $ 1 w 1 • Do CRO -1210 NC State Board of Elections Aorii 2007 Contributions from Individuals pg 2 of Amendment ❑Yes 4WNo Use this form to report individual contributions over $50 or contributions nnder S90 if fnrrn rrRO t 9nc :o .,..t „wa 1. Committee Full Name (and Fund if appucabi 2. ID Number Colleen 6molmiL pof Om Dt5buf I 3. Contributor Information Add ❑Remove . Full Name, Mailing Address & Phone b. Job Tide d. Comments (include city, state, & zip) — — - ./tP,,ofession ,r I n VPS 1 f ll m "n� P — — 1 I'e I I ss A Size rn all a d P s NOP C. Employer's Name/Specific loll CoNMOne, Rd MlnfV1llfj NL 288b3 CAI'IRUST Fli1anued e. Election Sum to Date Is 100,00 .Prior g. Aaromt Code h. Form of Payment L In -Kind Description - J. Date (mm/dd/yyyy) k.Amount I Dhllvle 1,0),OZ2- $ 100,00 ❑ $ ❑ $ . Contributor Information Add ❑ Remove . Full Name, Mailing Address & Phone b. Job Title/Professioo d. Comments (include city, state, & zip) -- i1CCuuvti'fnwt _ - Qifmse W&ittt Rollins c Employer's NamelSpeclttc Field 1 b 1 S E f tea n kl 10 S> MoA ntf l N C 24slI2 Ulm Ag OUnilnq e, Election Sumto Date Se W 1C -Cs $ 600 .Oo . Prior g. Account Code b. Form of Payment L In -Kind Description J. Date (mm/dd/yyyy) Ic Amount ❑ C%2(k- 031W17,Da2 $ 50b•00 ❑COUNTY CAA1PAION FINANCE $ ❑ MAY 0 5 202 $ Contributor Information Add ❑ Remove . Full Name. Mailing Address & Phone rl C: L N—bq 1pftl9ndon d. Comment, (include city, state, & zip) _- — �C(dUf1�'/i, - colmn M16KCQ )'Imofn� Z I Employer's NamfdSpu- Field Ar(�" U1NA r11/1 v1t1 1 AIG 2� 1 I Z R e cool o u d '1lVfltVl Iv a Election Sam to Date $ 10M.00 i. Prior g. Account Code h Form of Payment i. In -Kind Description '. Date (mm/ddbrm) k Amount ° 1 C l C)12 -a2 $ 5 D0.00 ° 1 CYIP, k- d Wj-1OZz. $ 500.OD ° w eh� i 4e. 021o212oZ $ 2q too 4. Total on1v this Page $ ( 00 5. Total of ALL CRO -1210 Pages $ I a9 O� 07* Dine be (ins 6 Detailed Summary Page muss on of CRO -]100) CRO -1210 NC Seale Board of Elections April 2007 Disbursements Pg of 1 Amendment ❑ yea No Use this form to report expenditures from the committee for operating expenses, contributions to candidate political committees and coordinated nartv exnendirnres 1. CommitteeFull Name (and Fnnd it applicable) _. _ .-. _ _Number CulLun Omolnik- fbf WDistvt(f i 3. Type of Dlsb»rsement (Plewe ase senm_me CRO F3I0 fonmt for each bye of Disbursement.) Operating Expenses ❑ ContribuRons to Ca"dates/Political Committees ❑ Coordinated Party Es ndi- 4. Payee Information Add Ll Remove a. Full Name, Mailing Address & Phone b. Coordinated Committee Name d. Comments (include city_, state, &.00— .L s tg n m a 1 t � � I n c 31 L) 6 Dep S+- c. Level Registered (Specify) ❑ Federal ,County: " ys„ 0 1"t 1 c 2 8 117- Irl �V ❑ State ❑ Municipality: e. Election Sum to'Daite� Is b42 - vDv . Account Code g. Form. of Payment k POMOW Code L Date (mm/dd/yy) —1-6431 J.Anwrnn k Required Remarks ChtCk 2ozzs 642•Do .- Qrd sl n S I 4. Payee information I -U Add U Remove . Full Name, Mailing Address & Phone b. Coordinated Committee Name d. Comments (include city. state, & zip) Logos PINS by LLinn Inc c Level Registered (Specify) -- ❑Federal nty: 011-1 E L h 1 O✓1 V I I I.t nd w h T✓p 1 I Rd m Qn f�-e N C 2-% 110 ❑ State ❑ Municipality: e. Election Sto Date nSumf $ ` O fy f. Account Code g. Form of Payment b. Purpose Code L Date (mm(ddlyyyy) . Amount k R equired Renerour/ks hf B I$ 2ozz $(a5�1. Huts Shirts $ 4. Payee Information s ., Add ❑ Remove . Full Name. Mailing Address & Phone b. Coordinated Committee Name d. Comments (include city, state, & zip) - — - office MAX UNION COUNTY ;-WPAIGN FINANCE vet Registered (SQedty) Federal County: MAY 0 5 2022 ❑ sure ❑ Municipality: a Election Sam to Date . Account Code g. Form of Payment J. Amount JIL Required Remarks 1 de{71t CAVId _ $ _mm/ddlyyyy) 03 8 2012 $ i30.1 1 CQStbm huh t $ S. Total only this Page ?` s. $ 6. Total of ALL CRO -1310 Pages (This fine goes in line 13a ofDemiled Summary Page CRO -1100 if Operating Expenses) is Line t 1 ^ ,-u $ I u�-�• (Thgoes in line 13b of Detailed Summary Page CRO -1100 if Contrib to Candidates/Politico! Comm) (This fine oes in line 13c o Detailed Summary Pare CRO -1100 if Coordinated Party Expenditures) 7. Purpose Codes (List detailed expenditure code ove) * - Media Be - Printing C* - Fundraising D - To Another Candidate c - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* Other *Codes require detailed explanation in required remarb field k NC gate noara or Giections December 2009 Amendmet Aggregated Non -Media Expenditures Page _L „r J_ [3Yes No Optional form used to report NC Non -Media Expenditures of $50 or less. 1. Connalftee Fail Nun (and Fund_ app. _, . e . _ _ CCoKan bmoln►l�- Puv Boy �Is�l-rte I um er 3. Payee Information a. Amend b. Account Code c. Form of Payment d. Purpose Code e. Date (mmtdd/yyyy) f. Amount Q. Required Remarks ❑ Add ❑ Remove 1 ,,,,PP / dehf-cco C.1 (� CJ 03111$12A� $ 2 S,(p 2- P /��f F)U53jUb lUtd-S Add ❑Remove I ,JAJ llu�JVL ' I/Q rd 6 a 07l�toIwaa $4a,_)o �&StNss cdkzl, Add ❑ Remove L / �/ bIT lQ r(� g /'t� 03)25 2o2 -Z $ 2'I .4� t� /���� e NaVN rjcACk Add ❑ Remove I,, / ` r l,Q aL 0 02 2 q '7 ,, W z2 (�<J $ 1 D ' 00 r Fj' n Lj Add ❑ Remove l�i C Q1- 2 51 U2 Z $ II S 1 t a.l'fi a Lj Add ❑ Remove I QIYU nnlli IP4tEa c VJ W% Z $ `j •%�, S Add ❑ Remove 1 r Ili VliHf C V `' I z5 ZO.- Z $3.2—o S Add ❑Remove 1 ,_ eUcVwlll[IyVan&r 0,.II5)t-oI1 $IQ13-7 fs Cheeks Lj Add ❑ Remove ` CQ ydLj C1 —office Add ❑ Remove I ,.'VIN (A�f/l� (61 4 0 b3og 2027- $ 29 OD W Q bin k Add ❑ Remove I` ��,,�1� t/wlds�l CQ Y'V7I 0( 4J� ^� 207a-Lj q 1� $ 2/� I ' U �� �✓1 d W� Add ❑ Remove 1 t�Y/'tf1 W�"U V N /N7i2 $ L5. 00 (v (]r w K Add ❑ Remove $ o f� Add ❑ Remove $ $ $ rRemove Lj NION COUN N FINAN E$ ❑ Remove $ Add ❑ Remove $ —7-2 1a5. -I 4. Total only this Page 5. Total of ALL CRO -1315 Pages $ (This line must be on line 14 of Detailed Summwy Page CRO -/100) 6. Purpose Codes (List detailed exi)enditure code in (d) above) 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* - Donations to Legal Expense Fund O* - Other * Codes require detailed ex lanation in required remarks field CRO -1315 NC State Hoard of Elections December 2009 Amendment yyy, In -Kind Contributions Pg Of ❑ Yes No Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund. .thin 7 d Use CRO -1215 if In-KindConmbunons were or will be refunded wi a s. 2. ID Number 1. Committee Full Name (and Fund if applicable) _ _ - -- Co i f V1 VA M0 In aL v 606 I . Contributor information ❑ Add ❑ Remove . Full Name. Mailing Address & Phone b. Type of Contributor c. Comments (include city, state, & zip) `t Lan yt/1�J�d7a/t ,/� yt� 1//',{/ I Lan iYIN,'�/Ur a6U M01Wk Individual Candidate ❑ Party —Co 1 Z I /�✓G I (.(Jl �/ I ❑PAC ❑ Referendum d. Election Sum to Dale p Y y l O I 1 A] 2 8 I I Z pt Source$^ ❑ Other Receipt arO e. Description _ _ _. _ f. Date (mmtdd/yyyy) &`Fair Market Amount - qid fuv W�eb�vk l'bV14v �oL,zozi $ 2_q.00 $ $ 3. Contributor Information ❑ Add Remove . Full Name, Mulling Address & Phone bt-Type- Co°udbutor u Individual c. Comments (include city, state, & rJp) - - ❑ Candidate ❑ Party ❑ PAC d. Election Sum to Date ❑ Referendum ❑ Other Receipt Source $ f. Date (mm/ddlyyyy) g. Fen' Market Amount . Description- $ $ Contributor Information ❑ Add ❑ Remove . a. Full Name, Mailing Address & Phone b. T,vpe of Contributor Comte°ts ❑ Individual (include chy, state, & zip) UNION COUNTY ❑ Candidate CAMPAIGN FINANCE ❑ Pay,❑ id. PAC MAY 0 5 2022 ❑ Referendum Election Sum to Date ❑ Other Receipt Source $ RECEIVED f. Date (mffWddlyyyy) g. Fair Market Amount _ e. Description _ - -. _ -- 4. Total only this Page $ 2 ' cro 5. Total of ALL CRO -1510 Pages $ -7-Li . UO (M line must be on line 17 of Detailed Summary Page CRO -1100) December 2067 B d f hl^ '^ -- CRO -1510 NC State oar n