Kerr, James_2021-Org-DisclosureDisclosure Report Cover Amendment
❑ Yes M No
Use this form for general report and committee information, must be signed and submitted along with other detailed forms.
Do not List this form to update information.
1. Committee Information
. Full Name
c. ID Number
Kerr for Council
b. Mailing Address (include City, State and Zip Code) _
d. Date Filed
Attn: John W. Kapelar
114 N. Church Street,
Monroe, NC 28112
7, _ Z
e. Phone Number
704-283-8189
2. Report Year
3. Period Start Date mm/d 4. Period End Date mm/a
5. Treasurer Fall Name
2021
John Walter Kapelar
6. T of Committee Check One
9. Type of Report (check only one type o report from one category)
Candidate Campaign ❑ Party
❑ PAC ❑ Referendum
❑ Independent Expenditure ❑ Joint Fundraiser
❑ Legal Expense Fund
Municipal
State/County
Referendum
0 Organizational
❑ Thirty-five du%
❑ Pre-primary
Organizational
Quarterly
❑ First
■ Organizational
❑ Pre -referendum
❑ Final
❑ Pre-election
13Pre-mnoff
Semi-annual
❑ Mid Year
❑ Second
❑ Third
❑ Fourth
Semi-annual
❑ Supplemental Final
❑ Annual
❑ Special
. T e of FLLnd (if applicable. check one)
❑ Booster Fuad
❑ Building Fund
❑ Other.
❑ Year End
❑ Final
❑ Special
❑ Mid Year
❑ Year End
❑ Final
❑ Special
10. S al Report Name
8. Number of Fundraisers this Report
11. Account Information
11. Account Information JJNION
. Financial Institution Full Name
a. Financial institution Full Name CAMH/'
I 021
American Bank
.Purpose
e. Account Code
b. Purpose
c. Account Code
FoR NLL C W%PA(Czrt
JK3387
RECEi�/ .-
E&K KSES
it. Period Begin Balance
it. 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 farther certify that this
report is complete, we and correct and that I have been trained by the NC State Board of Elections.
John W. Kapelar &,Aj t.%.f • Z
Printed Name of Signer Signature of A orated Trcazurer Date
FOR OFFICE USE ONLY
Method
Date Received: a Employee:
Mail
kNormaIvery
Date Postmarked: Employee: Registered Mail
Hand Delivered
Date Scanned: Employee: ❑ Electronically Filed
Date Data Entered:Employee: [3Signer has not received
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-2IOOA-E) to make committee changes.
c,nv-a uur Nu state roam or trectlons August 2008