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2021-9-25-35DayReport-remarksRECEIVED Disclosure Report Cover SEP 2 4 2021 E3 Ye men® No Use this form for general report and conmittee information, must be signed and submitted along with other detailed fours. Do not use this form to update information. Ugi,n CO. BOcfd Oi E!tic85 1. Committee Information a. Full Name c. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY b. Mailing Address (include City, State and Zip Code) d. late Filed 9108 UNIONVILLE-BRIEF RD 09/22/2021 MONROE, NC 28110 e. Phone Number (704) 753-4782 2. Report Year 3. Period Start Date (mm/dd/yy) 4. Period End Date (mm/d y) 15. Treasurer Fall Name 2021 01/01/2022 09/21/2021 JOHN KIBLER 6. Type of Committee Check 9. Tvve of Re pport (check only one type of re ortour one category) ® Candidate Campaign ❑ Party Municipal State/County Referendum ❑ Joint Fundraiser ❑ PAC ❑ Organizational ❑ Organizational ❑ Organizational ❑ Referendum Legal Expense Fund ® ❑ ❑ Thirty-five day Pre-primary Pre-election Quarterly ❑ First ❑ Second ❑ Pre-referendmn ❑ Final ❑ Supplemental Final 7. Type of Fund ((fapplicable, check one) ❑ "Booster Fond" ❑ Building Fwd ❑ Pre-natoff ❑ Third ❑ Annual ❑ Presidential Election Year Candidates Fwd Semi-annual ❑ Fourth ❑ Special ❑ NC Public Campaign Financing Fwd ❑ Mid Year Semi-annual ❑ Year End ❑ Mid Year 10.5 Peeial Re port Name ❑ Other ❑ ❑ Final Special ❑ Year End ❑ Final ❑ Special S. Number of Fundraisers this Report 4 3. Account Information 3. Account Information a. Financial Institution Full Name a. Financial Institution Full Name U WHARRIE BANK b. Purpose c :%ccount Code b. Purpose c. Account Code CHECKING ACCOUNT 228 FOR CAMPAIGN it. Period Begin Ralance d. Period Begin Balance S S 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 co ct and that ave n trained by the NC State Board 09/23/2021 Printed Name of Signer Signature of Appointed Treasurer Date FOR OFFICEiSEONLY i Delivery Method Date Received: t�4`(� E ployee: ❑ Normal Mail ❑ Registered Mail Date Postmarked: Employee: ❑ Hand Delivered ® Electronically Filed Date Scanned: ErTloyee: E3 Signer has not received Date Data Entered: Employee: mandatory training Please Note: This formcannot be used to amend committee information such as the committee address, treasurer, assistant treasurer, custodian of books information, oraccount infomration. You must amend the Statement of Ormanization CRO -2100A- to make con rnittee changes. CRO -1000 NC State Board of Elections December 2007 IIL%-.#CIvCU SEP 2 4 2021 Amendment Detailed Summaryii�II ((� �ff FF ❑ Yes ® No Use this formto summarize all disclosure reporting forrns anti�i�%C�lA8l 1�t k'�tion 1. Committee Full Name and Fund ifapplicable)72"021 of Report 3. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS Thirty -five-day Start of Election Cycle: January 1, 2021 Total this Reporting Period Total this Election Cycle 4) Cash on Hand at Start $ 1,202.84 $ 0.00 RECEIPTS 5) Aggregated Contributions from Indi-viduals 6) Contributions from Individuals 7) Contributions from Political Party Committees 8) Contributions from Other Political Committees 9) Loan Proceeds 0) Refunds/Reimbursements to the Committee 1) Other Receipt Sources 1 la) Interest on Bank Accounts I l b) Contributions from Nat -For -Profit Organizations 1 I c) Outside Sources of Income 11d) Legal Expense Fund - Other Sources 11e) Exempt Purchase Price Sales (CRO -1205) (CRO -1210) (CRO -1220) (CRD -1230) (CRD -1410) (CRO -1240)$ {CRO -1250) (CRD -1250) (CRO -1250) (CRO -1270) (CRO -1265) $ 0.00 $ 0.00 $ 0.00 $ 2,571.12 $ OAO $ 50.00 $ 0.00 $ 0.00 $ 0.00 $ OAO 0.00 $ 0.00 $ $ 12.00 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 2) TOTAL RECEIPTS (Add lines 5,6,7,9,9,10,1 N, I I b, l I e, l 1 d and I le) $ 0.00 $ 2,633.12 EXPENDITURES 3) Disbursements 13a) Operating Expenditures 13b) Contributions to Candidates/Polideal Committees 13c) Coordinated Party Expenditures 4) Aggregated Non -)Media Expenditures 5) Loan Repayments 6) Refunds/Reimbursements from the Committee 7) In-I(indContributions (CRO -1310) (CRO -1310) (CRO -1310) (CRO -1315) (CRO -1420) (CRO -1320) (CRO -1510) $ 0.00 $ 1,304.16 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 126.12 8) TOTAL IXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ 0.00 $ 1,430.28 9) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18) $ 1,202.84 $ 1,202.84 ADDITIONAL INFORMATION t}) Nan -Monetary Gibs Given to Other Committees 1) Outstanding Loans (incl. ones from other campaigns) 2) Debts and Obligations owed by the Committee 3) Debts and Obligations owed to the Committee 4) Account Transfers Within the Committee 5) Administrative Support 6) Forgiven Loans 7) 48 -Hour Notice Reports Sum (CRO -1330) (CRO -1430) (CRO -1610) (CRO -1620) (CRO -1720) (CRO -1710) (CRD -1440) (CRD -2220) $ $ $ $ $ $ 0.00 0.00 0.00 0.00 0.00 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 8) Contributions to be Refunded (CRO -1215) $ 0.00 t$ 0.00 CR04100 NC State Board of Flections August 2008 Amendment Contributions from Individuals Pg I of 13 ❑ 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 ifapplicable) 2. ID COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments CAREER ADVOSOR CYNTHIA BAEZ 4014 CLOUD VIEW LANE INDIAN TRAIL, NC 28079 (518) 8524124 c. Finployer's Name/Specific Field NC DEPT OF COMMERCE e. Election Sum to Date S 25.00 f. Prior g. Account Code h. Form of Payment i. In -hind Description J. Date (mmlddlyyyy) k. Amount 11 228 Check 09/20/2021 $ 25.00 ❑ g ❑7 S 3. Contributor Information ❑ Add ❑ Remove a. Full'Name, Mailing Address & Phone (include city, state, & zip) b. Job litlelProfession d. Comments RETIRED MEDIA SPECIALIST JO BARBRE 2300 WHILDEN CT CHARLOTTE, NC 28211 (704) 366-1748 c. Employer's Name/Specific Field CHARLOTTE MECKLENBURG SCHOOLS e. Election Sum to Date $ 20.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ "� Check 08/30/2021 S 20.00 ❑ S 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Titleff rofession d. Comments UNEMPLOYED JOHN T BELK 209 WEST HWY 218 MONROE, NC 28110 (704) 753-1829 c. Employer's Name/Specific Field UNEMPLOYED e. Election Sum to Date $ 100.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mmlddlyyyy) k. Amount ❑ 228 Check 09/21/2021 5 100.00 ❑ $ ❑ $ 4. Total only this Page $ 145.00 5. Total of ALL CRO -1210 Pages (This line must be on line h ufDelailed Summary Page CRO -1100) $ 2,596.12 CRO -1210 tit_ Slate Board oI Flcctions April 2007 Contributions from Individuals Amendment Pg 2 of 13 ❑ Yes ® N use Lina rum or ropurr murv(uua( curl moo Lions uvcraworconmouoons unaeraou rrronnr.xv rtvz) is not usea 1. Commitice FLIT Name and Fund if cable 2. ID Nnmbor COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY ription 3. Contributor hiformation ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments RETIRED MATERIALS MANUFACTURER LARRY CARTER 416 EAST HWY 218 MONROE, NC 28110 (704) 753-1072 c. Employer's Name/Specific Field SOUTHEASTERN METAL PRODUCTS, CHARLOTTE, NC e. Election Sum to Date $ 50.00 f. Prior g. Account Code h. Form of Payment i. In-IGnd Description I. Date (mm/dd/yyyy) k. Amount ❑ 228 Check ription 09/01/2021 $ 50.00 ❑ 08/27/2021 $ 200.00 $ ❑ $ 300.00 $ 3. Contributor Ltormadon ❑ Add 0 Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession Fri. Comments EMILEE CONRAD NC c. Employer's Name/Specific Field E Prior g. Account Code It. Form of Payment i.ln-Rini ❑ 228 Credit Card 13 3. Contributor Information a. Full Name, Mailing Address & Phone (include city, state, & zip) WILLIAM G CREEL 4703 TOWNSHIP WALK MERIETTA, GA 30066 f. Prior g. Account Code h. Form of Payment i. In -Kin( ❑ 228 Check 4. Total only this Page 5. Total of ALL CRO -1210 Pages (This line mast he on line 6 ojDelailed Summary Page CRO- 1 CRO -1210 he SAL e. Election Sum to Date $ 50.00 ription I. Date (mm/ddlyyyy) k. Amount 09/01/2021 $ 50.00 Add ❑ Remove b. Jobntle/Professios d. Comments RETIRED SECRET SERVICE EN c. Employer's Name/Specific Field US FEDERAL GOVERNMENT e. Election Sum to Date $ 200.00 ription I. Date (mm/ddlyyyy) k. Amount 08/27/2021 $ 200.00 $ 300.00 $ 2,596.12 ird o f Elections Avrd 2007 Amendment Contributions from Individuals Pg 3 of 13 ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 iffonn CRO 1205 is not used 1. Committee Fibil Name and Fund if applicable) 2. ID Number COMMITTITI TO RE-ELECT PATRICIA IIELMS KINDI,FY 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments JENNIE K DISHMAN 3800 SHAMROCK, DRIVE CHARLOTTE, NC 28215 (704) 516-9835 c. Rnployer's Name/Specific Field e. Flection Sum to Date $ 50.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/ddlyyyy) k. Amount 0 228 Check 09/14/2021 S 50.00 ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full varve, Mailing Address &Phone (include city, state, & zip) h. Job 'II lelProfession d. Comments RETIRED RN KATHLEEN DOMANSKI 3714 BANYAN WAY WAXHAW, NC 28173 (704) 618-4116 c. Employer's Name/Specific Field UNION ATRIUM e. Flection Sum to Date $ 100.00 f. Prior g. Account Code h. Form of Payment 1. In -Kind Description j. Date (mm/ddlyyyy) k. Amount ❑ 228 Credit Card 09/21/2021 $ 100.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job TitlelProfession d. Comments UNEMPLOYED KAY EWARDS 9108 UNIONVILLE BRIEF ROAD MONROE, NC 28110 (704) 7534782 c• Employer's Name/Specific Field UNEMPLOYED e. Election Sam to Date $ 60.00 E Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mmlddlyyyy) k. Amount 13 228 Check 07/29/2021 $ 50.00 ❑ 228 Cash 49/02/2021 $ 14.00 j i i . -L 4. Total only this Page $ 210.00 5. Total of ALL CRO -1210 Pages (This line must be online h ofDelailed Summary Page CRO -1100) $ 2,596.12 CRO -1210 NC trate Board of Flections April 2007 Amendment Contributions from Individuals Pg 4 of 13 ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee bLtl Name and IAtnd ifs icable 2. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor htformation ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job 71tle/Profession d. Comments COMPUTER NETWORK ADMINISTRATOR DAVID FRYD 9923 HARRISBURG RD FORT MILL, SC 29707 (602) 617-2705 c. Employer's Name/Specific Field INDEPENDENT CONTRACTOR e. Election Sum to Date $ 20.00 f. Prior g. Account Code h. Form of Payment 1. In -Kind Description I. Date (mm/dd/yyyy) k. Amount ❑ 228 Cash 08/26/2021 $ 20.00 ❑ $ 3. Contributor f Mourn all: ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Trtle/Profession d. Comments RETIRED SALES GERALD GADDY 6821 CONCORD HIGHWAY MONROE, NC 28110 (704) 7534246 c. Employer's Name/Specific Field DYKE INDUSTRIES e. Election Sum to Date $ 50.00 f. Prior g. Account Code It. Form of Payment I. In -Kind Description I. Date (mm/dd/yyyy) Is. Amount 13 228 Cash 09/17/2021 $ 50.00 ❑ $ ❑ $ 3. Coatrlbutor Tntorma8m ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession it. Comments RETIRED TEACHER ALETA GALUSHA 8428 WHITEHAWK HILL RD WAXHAW, NC 28173 (704) 256-9294 c. Employer's Name/Specific Field CATHOLIC CHARITIES e. Election Sum to Date $ 20.00 L Prior g. Account Code It. Form of Payment i. In-IGnd Description j. Date (mm/dd/yyyy) Is. Amount ❑ 228 Credit Card 09/07/2021 $ 20.00 ❑ $ ❑ $ 4. Total only this Page $ 90.00 5. Total of ALL CRO -1210 Pages (This line must be on fine 6 of Derailed Summary Page CRO -/100) $ 2,596.12 CRO -1210 NC .State Board of Elections April 2007 Contributions from Individuals Amendment Pg 5 of 13 ❑ Yes IN No Use this forth to report individual contributions over $50 or contributions under $50 if forth CRO 1205 is not used 1. Comtadttee Fun Name and Fund ifs cable 2. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor Lformation ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) It. Job 7itle/Profession d. Comments CORPORATE OFFICER ALICE HABBAL 1416 EAST BRIEF RD MONROE, NC 28110 (704) 7534855 c. Employees Name/Specific Field VISION OFFICE SYSTEMS e. Election Sum to Date $ 100.00 f. Prior g. Account Code h. Form of Payment I. In -Kind Description j. Date (mm/ddlyyyy) It. Amount ❑ 228 Check 07/29/2021 $ 100.00 ❑ $ ❑ $ 3. Coatribalor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job 7itle/Prefession d. Comments SALES JAN HAIGLER 9906 INDIAN TRAIL-FAIRVIEW RD INDIAN TRAIL, NC 28079 c. Employer's Name/Specific Field H&H FARM MACHINE CO e. Election Sum to Date $ 100.00 f. Prior g. Account Code h. Form of Payment 1. In -Kind Description j. Date (mm/dd/yyyy) it. Amount ❑ 228 Check 08/27/2021 $ 100.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job 7ltle/Profession d. Comments RETIRED RETAIL RHEBA HAMILTON 3353 DRIFTWOOD DR CHARLOTTE, NC 28205 c. Employer's Name/Specific Field JC PENNY e. Election Sum to Date $ 25.00 f. Prior g. Account Code h. Form of Payment I. In -Kind Description j. Date (mm/dd/yyyy) it. Amount ❑ 228 Check 08/16/2021 $ 25.00 ❑ $ ❑ $ 4. Total only this Page $ 225.00 5. Total of ALL CRO -1210 Pages (This tine must be on tine 6 of Detailed Summary Page CRO -1100) $ 2,596.12 CRO -1210 ti( �ie 8osr'l n t FJectisn, April 2007 Amendment Contributions from Individuals Pg 6 of 13 ❑ Yes IN No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used ]. Committee Full Dame and Fund if applicable) 2. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job'litle/Profession d. Comments RETIRED TEACHER ELLA HARGETT 208 WILLIAMS RD PO BOX 13 WINGATE, NC 28174 (704) 233-4114 c. Employer's Name/Specific field UNION COUNTY PUBLIC SCHOOLS e. Flection Sum to Date S 50.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount 0 225 Check 09/17/2021 $ 50.00 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, &zip) b. Job'litle/Profession d. Comments TEACHER KIM HARGETT 7817 WHITE STORE RD MARSHVILLE, NC 28103 c. Employer's dame/Specific Field UCPS e. Election Sum to Date $ 50.00 f. Prior g. Account Code h. Form of Payment i. In -mind Description j. Date (mm/dd/yyyy) k. Amount ❑ 78 Credit Card 09/01/2021 $ 50.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, /Nailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments UNEMPLOYED JONAS HARRIS 613 WHITE TAIL TERRACE WAXHAW, NC 28173 (704) 243-7113 c. Finployer's Name/Specific Field UNEMPLOYED c. Election Sum to Date $ 50.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mmlddlyyyy) k. Amount ❑ 228 Credit Card 09/16/2021 $ 50.00 ❑ $ 4. Total only this Page $ 150.00 5. Total of ALL CRO -1210 Pages (This line must he online b of Detailed Summary Page CRO -1100) $ 2,596.12 CRO --1210 NC State Board of lilections April 2007 Amendment Contributions from Individuals Pg 7 of 13 ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 ifform CRO 1205 is not used 1. Committee Full Name and Fund ifapplicable) 2. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job"title/Profession d. Comments RETIRED ART TEACHER JUDITH HEFNER 14606 MARGLEN DR MIDLAND, NC 28107 (704) 888-1374 c. Fmployer's Name/Specific Field CHARLOTTE MECKLENBURG SCHOOLS e. Flection Sum to Date $ 25.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/ddlyyyy) k. Amount ❑ 228 Check 09/02/2021 $ 25.t)ti 3. Contributor Information ❑ Add ❑ Remove a. Full Name, mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments RETIRED INTERIOR DESIGNER RUTH HELMS 2201 MELODY DR MONROE, NC 28110 (704) 289-5358 c. Employer's Name/Specific Feld SELF e. Flection Sum to Date $ 100.00 f. Prior g. Account Code h. Form of Payment i. In -hind Description j. Bate (mmldd/yyyy) k. Amount ❑ 228 Check 08/16/2021 S loo.()() ❑ S ❑ 5 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) h. Job'litle/Profession d. Comments RETIRED JOHN KIBLER 3614 S ROCKY RIVER RD MONROE, NC 28112 (704) 210-3087 c. Employer's NamelSpecific Field e. Election Sum to Date 95.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mmldd/yyyy) k. Amount ❑ 228 Credit Card 09/01/2021 25.00 ❑ 228 Credit Card 09/01/2021 $ 50.00 ❑ 228 Credit Card 09/02/2021 $ 20.00 4. Total only this Page 220.00 5. Total of ALL CRO -1210 Pages (This litre must be on line b of Derailed Summary Page CRO -1100) $ 2,596.12 CRO -1210 NC State Board of Elections April 2007 Amendment Contributions from Individuals Pg 8 of 13 ❑ Yes ® No Use this fortn to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee FLII Name and FLnd if applicable) 2. ID Nn�ler COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job litle/Profession d. Comments ADMINISTRATIVE SPECIALIST DEAN KINDLEY 1434 MITCHELL AVE TALLAHASSEE, FL 32303 (850) 688-3393 c. Employer's Name/Specific Field CITY OF TALLAHASSEE FLORIDA e. Election Sum to Date $ 100.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/ddlyyyy) Is. Amount ❑ 228 Check 08/30/2021 $ 100.00 3. Contributor Information ❑ Add ❑ Remove a. Full Name, flailing Address & Phone (include city, state, & zip) b. Job Ti tic/Profession d. Comments UNEMPLOYED JOYCE KOON 5511 HOLLY HILLS DRIVE WAXHAW, NC 28173 (803) 467-8219 c. Employer's Name/Specific Field UNEMPLOYED e. Election Sum to Date $ 25.00 I. Prior g. Account Code It. Form of Payment i. In -Kind Description I. Date (mm/dd/yyyy) k. Amount ❑ 228 Credit Card 09/16/2021 $ 25.00 ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job 7itle/Profession d. Comments MENTAL HEALTH PROFESSIONAL MICHAEL LANGE 3895 VALINDA DR WINSTON SALEM, NC 27106 (336) 815-8823 c. Employer's Name/Specific Field CARDINAL INNOVATIONS e. Election Sum to Date $ 100.00 E Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 228 Check 08/27/2021 $ 100.00 ❑ $ 4. Total only this Page $ 225.00 5. Total of ALL CRO -1210 Pages (This line must be on line 6 of Detailed Summary Page CRO.1100) $ 2,596.12 CRO -1210 NC State Boardof Elections April 2007 Contributions from Individuals Amendment Pg 9 of 13 ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if forth CRO 1205 is not used 1. Committee Fail Name and Phad ifs icable 2. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b..lob "Btle/Profession d. Comments CLINICAL SOCIAL WORKER KARA LEMON 1204 STEVENS RD MONROE, NC 28110 (704) 242-4322 a Employer's Name/Specific Field THERAPEUTIC ALTERNATIVES e. Election Sum to Date $ 100.00 L Prior g. Account Code h. Form of Payment I. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 228 Check 08/16/2021 $ 100.00 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments RETIRED SOCIAL WORK PROFESSOR KRISTA KINDLEY MARTIN 4973 FOLLANSBEE ROAD WINSTON SALEM, NC 27127 (336) 793-7987 c. Employer's Name/Specific Field UNC SCHOOL OF SOCIAL WORK e. Election Sum to Date $ 126.12 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) It. Amount ❑ 218 In -Kind BANNERS ON THE CHEAP ORDER NUMBER 09/09/2021 $ 126.12 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments RETIRED MEDIA SPECIALIST. TEACHER BARBARA MCLAUD 222 WOOD LAKE DR MONROE, NC 28110 c. Employees Name/Specific Field UCPS e. Election Sum to Date $ 25.00 E Prior g. Account Code h. Form of Payment i. In -Kind Description J. Date (mm/dd/yyyy) k. Amount ❑ 228 Check 08/30/2021 $ 25.00 4. Total only this Page $ 251.12 5. Total of ALL C110-1210 Pages (This line must be online 6 ojDetailed Summary Page C110-1100) $ 2,596.12 CRO -1210 NC State Board of Elections April 2007 Amendment Contributions from Individuals Pg 10 of 13 ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Foil Name and Fland ifapplicable) 2. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) h. Joh'Dtle/Profession d. Comments BILL V MOSS NC c. Employer's Name/Specific Field e. Election Sum to Date $ 50.00 C Prior g. Account Code 1h. Form of Payment I. In -Kind Description j. Date (mm/dd/yyyy) Is. Amount ❑ 228 Credit Card 09/02/2021 $ 50.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, flailing Address & Phone (include city, state, & zip) h. Job Title/Profession d. Comments RETIRED TEACHER LORETTA PENDERGRAST 1719 EAST 8TH STREET CHARLOTTE, NC 28204 (704) 375-8977 e. Employer's Name/Specific Field CHARLOTTE MECKLENBURG SCHOOLS e. Election Sum to Date $ 50.00 f. Prior g. Account Code h. Form of Payment I. In -Kind Description j. Date (mm/dd/yyyy) k. Amount 0 228 Check 09/03/2021 $ 50.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Trtle/Profession d. Comments RETIRED TEACHER LORNA PRICE 630 E HIGHWAY 218 MONROE, NC 28110 (704) 989-1685 c. Employees Name/Specific Field UNION COUNTY PUBLIC SCHOOLS UCPS e. Election Sum to Date $ 100.00 f. Prior g. Account Code It. Form of Payment I. In -Mod Description j. Date (mm/dd/yyyy) It. Amount ❑ 228 Check 09/10/2021 $ 100.00 ❑ y 4. Total only this Page $ 200.00 5. Total of ALL CRO -1210 Pages (This line must be online 6 oJDerailed Summary Page CRO -1100) $ 2,596.12 CRO -1110 NC State Board of Elections April 2007 Amendment Contributions from Individuals Pg 11 of 13 ❑ Yes ® No Use this formto report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee FLIT Name and Flsad ifapplicable) 2. ID Number COMMITTEE TO RF, -ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b..lob Title/Profession d. Comments RETIRED TEACHER MARGARET F PROCTOR 1022 PREAKNESS BLVD INDIAN TRAIL, NC 28079 (704) 882-4487 c. Employer's Name/Specific Pletd UCPS e. Election Sum to Date $ 30.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) It. Amount ❑ 228 Check 08/16/2021 $ 30.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments RETIRED MEDIA SPECIALIST SUE ROBERTS 314 BASSWOOD CT LAKE WYLIE, SC 29710 (803) 631-5054 e. Employees Name/Specific Field CHARLOTTE MECKLENBURG SCHOOLS e. Election Sum to Date $ 50.00 I. Prior g. Account Code It. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 228 Check 08/30/2021 $ 50.00 ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments VETERINARIAN CLAUDIA SANDOVAL 2508 EAST 7TH STREET CHARLOTTE, NC 28204 (704) 993-6854 c. Employer's Name/Specific field UNEMPLOYED e. Election Sum to Date $ 100.00 f. Prior g. Account Code It. Form of Payment 1. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 228 Credit Card 09/15/2021 $ 100.00 ❑ $ ❑ $ 4. Total only this Page $ 180.00 5. Total of ALL CRO -1210 Pages (This line must be online 6 ojDeralled Summary Page CRO -1100) $ 2,596.12 CRO -1210 NCS ate Board of Elections Apri12007 Amendment Contributions from Individuals Pg 12 of 13 ❑ lies ® No Use this fornito report indi% dual 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 RE-ELECT PATRICIA HELMS KINDLEY $ 50.00 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Joblitle/Profession d. Comments DISTRICT RECREATION STAFF OFFICER k. Amount THERESA SAVERY 5401 OLIVIA COURT MARSHVtLLE, NC 28103 (303) 859-2795 c. Employer's Name/Specific Field USDA FOREST UWHARRIE NATIONAL FOREST e. Election Sum to Date $ 100.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 228 Credit Card 09/15/2021 $ 100.00 ❑ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments $ ❑ SARAH TALLEY 4141 GREENMEAD ROAD WINSTON-SALEM, NC 27106 (336) 408-8644 c. Employees Name/Specific Feld UNEMPLOYED e. Election Sum to Date Is 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone I b. Job Title/Profession Id. Comments (include city, state, & zip) KEITH SMITH NC C. e. Election Sum to Date $ 50.00 I. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 228 Credit Card 09/01/2021 $ 50.00 ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments UNEMPLOYED SARAH TALLEY 4141 GREENMEAD ROAD WINSTON-SALEM, NC 27106 (336) 408-8644 c. Employees Name/Specific Feld UNEMPLOYED e. Election Sum to Date $ 25.00 f. Prior g. Account Code It. Form of Payment I. In -Kind Description j. Date (mm/ddlyyyy) k. Amount ❑ 228 Credit Card 09/24/2021 $ 25.00 ❑ $ ❑ $ 4. Total only this Page $ 175.00 5. Total of ALL CRO -1210 Pages (This line must be on line 6 of Detailed Summary Page CRO -1100) $ 2,596.12 CRO -1210 NC Stale Board of Elections Aprd 2007 Contributions from Individuals Amendment Pg 13 of 13 ❑ Ves ® 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 Dumber COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ Remove a. Dull Name, ,\tailing Address & Phone (include city, state, & zip) b..lob'litle/Profession il. (umments LISA WALKER 5008 LAUREL GROVE LAANE MATTHEWS, NC 28104 (704) 458-6380 c. Employer's Name/Specific field e. ]•lection Sum to Date $ 150.00 f. Prior g. Account Code It. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 228 Credit Card 09/01/2021 100.00 ❑ 228 Credit Card 09/16/2021 S 50.00 ❑ S 3. Contributor Information 11 7d ❑ Remove a. lull Name. Mailing Address & Phone (include city, state, & zip) b..IobTitlelProfession d. Comments RETIRED TEACHER TINA WILSON 12105 WOODSIDE FALLS RD CHARLOTTE, NC 28134 (704) 576-1236 c. Employer's Name/Specific Field CHARLOTTE MECKLENBURG SCHOOLS e. Election Sum to Date $ 25.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mmlddlyyyy) k. Amount ❑ 228 Check 09/20/2021 $ 25.00 3. Contributor Information ❑ Add ❑ Remove a. Full %ante, Mailing Address & Phone (include city, state, & zip) b. Job Tttle/Profession d. Comments Executive Director of Elementary Schools BROOKE ZEHMER 106 TOMAHAWK RD LEXINGTON, NC 27295 (336) 596-3881 c. Employer's Name/Specific Field ROWAN-SALIBURY SCHOOLS e. Election Sum to Date $ 50.00 f. Prior g. Account Code h. Form of Payment i, In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 228 Credit Card 09/09/2021 $ 50.00 ❑ $ ❑ $ 4. Total only this Page $ 225.00 5. Total of ALL CRO -1210 Pages (Thu line must be on line 6 of Detailed Summary Page CRO -1100) $ 2,596.12 CRO -1210 NC State Board of Elections April 2007 Amendment Contributions from Political Party Committees Pg of 1 ❑ Yes ®Na Use this form to report contributions from a political party 1. Committee Full Name and Fand if a icable 2. to Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, &zip) b. Comments (INION COUNTY SENIOR DEMOCRATS (UNION SD) PO BOX 665 WAXHAW, NC 28173 (704) 618-4116 c. Election Sum to Date $ 50.00 d. Account Code e. Form of Payment L In -Kind Description g. Date (mm/ddtyyyy) h. Amount 228 Check 09/21/2021 $ 50.00 $ 4. Total only this Page $ 50.00 5. Total of ALL CRO -1220 Pages (This line must be on line 7 of Detailed Summary Page CRO -1100) $ 50'00 CRO -1210 NC Yate Board of Elections April 2007 amendment Refunds/Reimbursements To the Committee Pg of ! ❑ Yes ® No Use this form to report refunds received by the committee or reimbursements for a previous expenditure. 1. Committee Fall Name and Fund ifapplicable) 2. to Number' COMMITTEE TO RE. -ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) d. Type of Committee g. Comments 0 Candidate PAC ❑ Referendum ❑ Party UWHARRIE BANK 416 W MAIN ST LOCUST, NC 28097 (704) 888-8897 a. Level Registered (Specify) h. Original Fxpeoditure Date Federal 0 County: [3 State [3 Mwicipality: 08/31/2021 i. Original Expenditure Amt $ 12.00 b. Job Title/Profession It. Fmployer's Name/Specific Feld If. Purpose j. Election Sum to Date AMY BARBEE SAID WE WERE ACCIDENTALY CHARGED A $ 0.00 It. Account Code I. Form of Payment Im. In -Rind Description n. Date (mm/dd/yyyy) o. Amount 228 Draft 09/03/2021 $ 12.00 4. Total only this Page 1 $ 12.00 5. Total of ALL CRO -1240 Pages (This line must be online 10 of Detailed Summary Page CRO -1100) $ 12.00 CRO -1740 NC State Board of Elections December 2007 Amendment Disbursements Pg 1 of 8 ill Yea ® No Use this fonnto report expenditures fromthe connnittee for operating expenses, contributions to candidate/political committees and coordinated party expenditures 1. Committee Full Name and Fund if applicable) 2. ID Number COMMITTFF. TO RE-ELECT PATRICIA HELMS KINDLEY 3. Type of Disbursement (Please use seaarate CRO -1310 torms for each tvae o1 Disbursement,) IM Operating Expenses U CenlrltWtlOnS to Candidates/Political Committees Ll Coordinated Parte fspenditmes 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments DONORBOX.ORG (REBEL IDEALIST) 2615 COLUMBIA PIKE #427 ARLINGTON, VA 22204 c. Level Registered (Specify) Federal County: ❑ State ❑ Municipality: e. Election Sum to Date $ 14.04 E Account Code g. Form of Payment h. Purpose Code t. Date (mm/dd/yyyy) j. Amount k. Required Remarks 228 Draft O 09/01/2021 $ 0.38 APPLICATION FEE 228 Draft O 09/01/2021 $ 0.75 APPLICATION FEE 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city. state, & zip) b. Coordinated Committee Name d. Comments DONORBOX.ORG (REBEL IDEALIST) 2615 COLUMBIA PIKE #427 ARLINGTON, VA 22204 c. Level Registered (Specify) Federal U County: ❑ State ❑ Municipality: e. Election Sum to Date $ 14.04 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks 228 Draft O 09/01/2021 $ 0.75 APPLICATION FEE 228 Draft O 09/01/2021 $ 0.75 APPLICATION FEE 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zi b. Coordinated Committee Name d. Comments DONORBOX.ORG (REBEL IDEALIST) 2615 COLUMBIA PIKE #427 ARLINGTON, VA 22204 c. Level Registered (Specify) Federal U County: ❑ State ❑ Mmticipality: e. Election Sum to Date $ 14.04 f. Account Code Ig. Form of Payment Ill. Purpose Code it. Date (mm/dd/yyyy) 1j. Amount 1k. Required Remarks 228 Draft O 09/01/2021 IS 0.75 1 FUNDS TRANSFER FEE 228 Draft O 09/01/2021 $ 1.50 APPLICATIONFEE 5. Total only this Page $ 4.88 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CRO -1 100 if Operating Fxpenses) (This line goes in line 13h of Detailed Summary Page CRD -1100 lfConMb to CandidatesTofitical Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) $ 1,305.57 7.1"urpose Colles (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 Pudic 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 CRO -1311/ NC State Board of Elections Dcumber 2009 Amendment Disbursements Pg 2 of 8 ❑ Yes ® No Use this formto report expenditures fromthe 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 RE-ELECT PAI RICIA HELMS KINDLEY 3. ofDisbarsement(Please uaesevwweCRQl310formisfor each fvoeofDisbursement.) Operatin e Lx pen ses U Contriha ions to Candidates Poht lcal (John It ICC5 Lj Coordinated Party Expenditures 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments DONORBOX.ORG (REBEL IDEALIST) 2615 COLUMBIA PIKE #427 ARLINGTON, VA 22204 c. Level Registered (Specify) El Federal U County: ❑ Sate ❑ Municipality: e. Election Sum to Date $ 14.04 L Account Code g. Form of Payment h. Purpose Code I. Date (mm/ddlyyyy) j. Amount It. Required Remarks 228 Draft O 09/02/2021 $ 0.75 APPLICATION FEE 228 Draft O 09/07/2021 S 0.60 APPLICATION FEE 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include cit,state,&zip) b. Coordinated Committee Name d. Comments DONORBOX.ORG (REBEL IDEALIST) 2615 COLUMBIA PIKE #427 ARLINGTON, VA 22204 T Level Registered (Specify) Federal County: ❑ Sate ❑ Municipality: e. Election Sum to Date $ 14.04 f. Account Code g. Form of Payment It. Purpose Code I. Date (mm/dd/yyyy) j. Amount 1k. Required Remarks 228 Draft O 09/09/2021 $ 0.75 APPLICATION FEE 228 Draft ) 09/15/2021 $ 1.50 APPLICATION FEE 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) h. Coordinated Committee Name d. Comments DONORBOX.ORG (REBEL IDEALIST) 2615 COLUMBIA PIKE #427 ARLINGTON, VA 22204 c. Level Registered (Specify) Federal 0 County: ❑ Sate ❑ Municipality: e. Election Sum to Date $ 14.04 f. Account Code g. Form of Payment It. Purpose Code i. Date (mm/dd/yyyy) j. Amount it. Required Remarks 228 Draft O 09/15/2021 $ 1.50 APPLICATION FEE 228 Draft U 09/16/2021 S 0.38 1 APPLICATION FEE 5. Total only this Page $ 5.48 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (Thin line goes in line 13b ofDem Med Summary Page CRO -1100 ifContrib to Can didatec(PoliticaI Comm) (Thio line goes in line l3c of Detailed Summa R' Page CRO -I 100 if Coordinated Party Expenditures) $ 1,305.57 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 - Penultias K* -Office Expenses Q* - Donation to Legal Expense Fund O* Other * Codes require detailed explanation in re uiredremarks field CRO -13 / 0 NC Sate Board of Elections December 2009 Amendment Disbursements Pg 3 of 8 ❑ les ® No Use this formto report expenditures from the committee for operating expenses, contributions to candidate, political cortmiittees and coordinated party expenditures 1. Committee Fall Name and Fund if applicable) 2. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Type of Disbursement (Please use separate CRD -1310 forms for each tune ofDisbwrseme") IM Operating Fxpenses Contrlbnl ions to Candidates/Political Committees U Coordinated Party Expenditures 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments DONORBOX.ORG (REBEL IDEALIST) 2615 COLUMBIA PIKE #427 ARLINGTON, VA 22204 c. Level Registered (Specify) Federal 0 County: ❑ State ❑ Municipality: e. Election Sum to Date $ 14.04 C Account Code g. Form of Payment h. Purpose Code L Date (mm/dd/yyyy) j. Amount It. Required Remarks 228 Draft O 09/16/2021 $ 0.75 APPLICATION FEE 228 Drag O 09/16/2021 $ 0.75 APPLICATON FEE 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments DONORBOX.ORG (REBEL IDEALIST) 2615 COLUMBIA PIKE #427 ARLINGTON, VA 22204 c. level Registered (Specify) Ll Federal County: ❑ State ❑ Municipality: e. Election Sum to Date $ 14.04 L Account Code g. Form of Payment 1h. Purpose Code i. Date (mm/dd/yyyy) j. Amount 1k. Required Remarks 228 Draft O 09/20/2021 $ 0.30 APPLICATION FEE 228 Drag O 09/21/2021 S 1.50 APPLICATION FEE 4. Payee Information ❑ Add ❑ Remove a. Full Narne, Mailing Address & Phone (include city, state, & zi b. Coordinated Committee Name d. Com ments DONORBOX.ORG (REBEL IDEALIST) 2615 COLUMBIA PIKE #427 ARLINGTON, VA 22204 c. Level Registered (Specify) UFederal County: ❑ State ❑ Municipality: e. Election Sum to Date $ 14.04 L Account Code g. Form of Payment It. Purpose Code i. Date (mm/dd/v)vyl jAmount 1k. Required Remarks 228 Draft O 09/24/2021 $ 0.38 APPLICATION FEE $ 5. Total only this Page $ 3.68 6.'I'otal ofALLCRO-1310 Pages (Tlris line gars in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Detailed Summary Page CRO -1100 ifContrlb to Candidates/Polldcal Comm) (This line goes in line lac of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) $ 1,305.57 7. Purpose Codes (List detailed expenditure code in (h.) above) A* - Media R* - Printing C* - Fundraising D -To Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses I - Postage 3 - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* Other * Codes require detailed explanation in re uiredremarks field(k) CRi11310 NC Slate 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. ID Number s COMMITTEE TO RE-ELECT PATRICIA I IELMS KINDLEY I.of Dis hursement (Please use separate CRO -1310 form for each tune of Disbursement.) Operas -Expenses U Contrthutionsto candidates/Puliucal('omrniltees Coordinated Pan v 1xpendiluaes 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments STRIPE CORPORATON 185 BERRY ST SUITE 550 SAN FRANCISCO, CA 94107 (650)427-9276 c. Level Registered (Specify) Lj federal U Comity: ❑ .13tate ❑ Municipality: e. Election Sum to Date S 31.65 E Account Code 1g. Form of Payment 1h. Purpose Code ji. Date (mm/ddlyyyy) j. Amount k. Required Remarks 228 Draft O 09/01/2021 $ 1.03 1 PROCESSING FEE 228 Draft O 09/01/2021 $ 1.75 1 PROCESSING FEE 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments STRIPE CORPORATON 185 BERRY ST SUITE 550 SAN FRANCISCO, CA 94107 (650) 427-9276 c. level Registered (Specify) Federal County: ❑ State ❑ Municipality: e. Election Sum to Date $ 31.65 C Account Code g. Form of Payment h. Purpose Code 1. Date (mm/ddlyyyy) I. Amount k. Required Remarks 228 Draft 10 09/01/2021 $ 1.75 FUNDS TRANSFER FEE 228 Draft O 09/01/2021 $ 1.75 PROCESSING FEE 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) It. Coordinated Committee Name d. Comments STRIPE CORPORATON 185 BERRY ST SUITE 550 SAN FRANCISCO, CA 94107 (650)427-9276 c. Level Registered (Specify) U Federal U County: ❑ Slate ❑ Municipality: e. Election Sum to Date $ 31.65 f. Account Code g. Form of Payment h. Purpose Code ji.Date (mm/dd/yyyy) j..Amount k. Required Remarks 228 Draft O 09/01/2021 $ 1.75 PROCESSING FEE 228 Draft O 09/01/2021 $ 3.20 PROCESSING FEE 5. Total only this Page $ 11.23 6. Total of ALL CRO -1310 Pages (This line goes at line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 136 of Detailed Summary Page CRO -1100 ifCantrib to Candidale lPolitical Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Parry Expenditures) $ 1,305.57 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 Pudic 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 -13111 NC SYate Board of Elcetions December 2009 Amendmeut Disbursements Pg 5 of 8 0 Yes IN No Use this formto 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 COMMITTEF TO RF: F,LK4 PATRICIA HELMS KINDLEY 3. Type of Disbursement (Please use separate CRO -1310 forms for each tune ofDisbursemens.) IM Operating Expenses El Contributions to Candidatc 'P,ditical Committees U Coordinated Party- Expenditures 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments STRIPE CORPORATON 185 BERRY ST SUITE 550 SAN FRANCISCO, CA 94107 (650) 427-9276 c. Level Registered (Specify) Federal 0 County: ❑ State ❑ Municipality: e. Hection Sum to Date $ 31.65 E Account Code g. Form of Payment It. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks 228 Draft O 09/02/2021 $ 0.88 PROCESSING FEE 228 Draft O 09/02/2021 IS 1.75 PROCESSING FEE 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) It. Coordinated Committee Name d. Comments STRIPE CORPORATON 185 BERRY ST SUITE 550 SAN FRANCISCO, CA 94107 (650)427-9276 c. Level Registered (Specify) Federal U County: ❑ State ❑ Municipality: e. Flection Sum to Date $ 31.65 f. Account Code Ig. Form of Payment 1h. Purpose Code ji. Date (mm/dd/yyyy) 1j. Amount 1k. Required Remarks 228 Draft O 09/07/2021 $ 0.88 1 PROCESSING FEE 228 Draft O 09/09/2021 S 1.75 1 PROCESSING FEE 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b.Coordinate dCom mitteeNam c d.Com ments STRIPE CORPORATON 185 BERRY ST SUITE 550 SAN FRANCISCO, CA 94107 (650) 427-9276 c. Level Registered (Specify) Federal 13 County: ❑ State ❑ Municipality: e. Election Sum to Date $ 31.65 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount 1k. Required Remarks 228 Draft O 09/15/2021 $ 3.20 PROCESSING FEE 228 Draft O 09/15/2021 $ 3.20 PROCESSING FEE 5. Total only this Page $ 11.66 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) This line j Summary gr fComm) ( goes in line 136 o Detailed Summa Pa CRO -1 i CanMb to Candidates/PoRtiea/ Comm (This line goes in line lac of Detailed .Summary Page CRO -1100 if Coordinated Party Expenditures) $ 1,305.57 7. Purpose Codes (List detailed expenditure code in (h.) above) A* - Metfia B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G- Political Party H* - Holding Pudic Office Expenses I - Postage J - Penalties K* -Office Expenses Q* - Donation to legal Expense Fund O* Other * Corks require detailed explanation in required remarks field CRO> -1 ? //1 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 uartv expenditures 1. Committee Full Name and Fund if applicable) 2. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Type of Disbursement (Please use separate CRO43I0 forms for each type of Disbursement.) Operating Expenses Li Contributions to Candidates/Political Committees Coordinated Party Expenditures 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, &zi b. Coordinated Committee Name d. Comments STRIPE CORPORATON 185 BERRY ST SUITE 550 SAN FRANCISCO, CA 94107 (650)427-9276 c. Level Registered (Specify) El Federal 13 County: ❑ Slate ❑ Municipality: e. Election Sum to Date $ 31.65 L Account Code g. Form of Payment h. Purpose Code i. Date (mm/ddlyyyy) 1j. Amount k. Required Remarks 228 Draft O 09/16/2021 $ 1.03 1 PROCESSING FEE 228 Draft O 09/16/2021 $ 1.75 1 PROCESSING FEE 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include cit , state, & zi b. Coordinated Committee Name d. Comments STRIPE CORPORATON 185 BERRY ST SUITE 550 SAN FRANCISCO, CA 94107 (650)427-9276 c. Level Registered (Specify) Federal U County: ❑ State ❑ Municipality: e. Election Sum to Date $ 31.65 L Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks 228 Draft O 09/16/2021 $ 1.75 PROCESSING FEE 228 Draft O 09/21/2021 $ 3.20 PROCESSING FEE 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments STRIPE CORPORATON 185 BERRY ST SUITE 550 SAN FRANCISCO, CA 94107 (650)427-9276 c. Level Registered (Specify) Federal U County: ❑ state ❑ Municipality: e. Election Sum to Date $ 31.65 C Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) 1j. Amount 1k. Required Remarks 228 Draft O 09/24/2021 $ 1.03 PROCESSING FEE 5. Total only this Page $ 8.76 6. Total of ALL CRO -1310 Pages (This line goes in fine 13a of Detailed Summary Page CRO -1100 if0perating Expenses) (This line goes in line 136 of Detailed Summary Page CRO -1100 ifContrfb to Candidares�PoRBcal Comm) (This fine goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) $ 1,305.57 7. Purpose Codes (List detailed expenditure code in (h.) above) A* -Mettia 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 re uiredremarks field CRO -1310 NCYate i3oardof Elections December 2U09 Amendment Disbursements Pg 7 of 8 ❑ Yes ® No Use this formto report expenditures from the committee for operating expenses, contributions to candidate/political committees and coordinated party expenditures 1. Committee Full Name and Fund ifapplicable) 2. m Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Type of Disbursement (Please use separate CRO -1310 forms for each tune oftDisbursement.) Operating Expenses Lj C'ontributionsto Candidata,/Political Committees Lj Coordinated Party Lixpenditmes 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments SUPER CHEAP SIGNS 9200 WATERFORD CENTRE BLVD #100 AUSTIN, TX 78758 (866) 270-7446 a Level Registered (Specify) Federal County: ❑ State ❑ Municipality: e. Flection Sum to Date $ 1,084.00 f. Account Code g. Form of Payment b. Purpose Code i. Date (mm/ddlyyyy) I. Amount k. Required Remarks 228 Debit Card O 09/21/2021 $ 1,084.00 1 YARD SIGNS 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments TOWN OF FAIRVIEW 7516 CONCORD HWY MONROE, NC 28110 (704) 753-1981 c. Level Registered (Specify) 0 Federal 0 County: ❑ State ❑ Municipality: e. Flection Sum to Date $ 100.00 L Account Code g. Form of I'avment h. Purpose Code L Date (mm/ddtyyyy) j. Amount 1k. Required Remarks 228 Check C 08/24/2021 IS 50.00 1 PARK SHELTER RENTAL 228 Check C 09/21/2021 1 $ 50.00 1 FUM UNNG EVENT 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include cit., state, &zip) b. Coordinated Committee Name d. Comments U WHARRIE BANK 416 W MAIN ST LOCUST, NC 28097 (704) 888-8897 c. Level Registered (Specify) UFederal LJ Country ❑ State ❑ Municipality: e. Flection Sum to Date $ 0.00 f. Account Code g. Form of Payment It. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks 228 Draft O 08/31/2021 $ 12.00 BANK CHECKING FEE $ 5. Total only this Page - $ 1,196.00 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CRO-11001fOperating Expenses) (This line goes in line 131, of Detailed Summary Page CRO-11001ifContdb to CandidatevPolitical Comm) (Tins line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Parry Expenditures) $ 1,305.57 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 3 - 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 Boardof Elections December 2009 Amendment Disbursements Pg 8 of 8 ❑ Yes ® No Use this fonnto report expenditures from the committee foropetating expenses, contributions to candidate/political committees and coordinated party expenditures 1. Committee Fall Name and Fund if applicable) 7271D Number COMMITTEE TO RE-ELEC'I PATRICIA HELMS KINDLEY 3. Type of Disbursement (Please use separate CRO -1310 forms for each Noe ofDisharsentent.) IS Operatine Expenses Cunt ribs ions to Can didateJPolit ical Committees U coordinated Parte Expenditures 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone Include city, state, & zip) b. Coordinated Committee Name d. Comments VISTA PRINT NETHERLANDS BV COMPANY HUDSONWEG 85938 -LW VENLO UTLANDET, NORWAY, NC (866) 2074955 c. Level Registered (Specify) Federal 13 Comfy: ❑ State ❑ Municipality: e. Flection Sum to Date $ 63.88 f. Account Code g. Form of Payment 1h. Purpose Code i. Date (mm/ddlyyyy) J. Amount k. Required Remarks 228 Debit Card B 09/05/2021 $ 63.88 18 X 24 POSTERS $ 5. Total only this Page $ 63.88 6. Total of ALL CRO -1310 Pages (This line goes in line13a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 136 of Detailed Summary Page CRO -1100 if Contdb to Candidate✓Political Comm) (This line goes in line 13c of Detailed Summan' Page CRO -1100 if Coordinated Party Expenditures) $ 1,305.57 7. Purpose Cozies (List detailed expenditure code in (h.) above) A* - Media B* - Printing C* - Fltndraising D- To Another Candidate E - Salaries P - Equipment G - Political Party H* - Holding Pudic Office Expenses I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* Other * Codes require detailed explanation in re uiredremarks field(k) CRO -1310 NCV ate Board of Elections December 2009 Amendment In -Kind Contributions Pg 1 of ❑ Yes ® No Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fiord. Use CRO -1215 if In -Kind Contributions were or will be refunded within 7 days. 1. Committee Full Name and Fund if applicable) COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 2. ID Number 3. Contributor Information ❑ Add ❑ Remove a. Full .\time, Mailing .Address & Phone (include city, state, & zip) b. Type of Contributor c. Comments IN Individual ❑ Candidate ❑ ply ❑ PAC ❑ Referendum ❑ Other Receipt Source KRISTA KINDLEY MARTIN 4973 FOLLANSBEE ROAD WINSTON SALEM, NC 27127 (336) 793-7987 d. Election Sum to Date $ 126.12 e. Description f. Date (mmldd/yyyy) g. Fair Market Amount BANNERS ON THE CHEAP ORDER NUMBER 90230007 BANNERS FOR CAMPAIGN 09/09/2021 $ 126.12 4. Total only this Page $ 126.12 5. Total of ALL CRO -1510 Pages (Tbk line mus[ be on line 17 gfDemOed Summary Page CRO -1100) $ 12612 CRO -1510 NC State Board of Elections December 2007