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Kindley,Patricia_2021-Pre-ElectionReportAmendment Disclosure Report Cover o__Yes W No Use this form for general report and committee information, crust be signed and submitted along with other detailed forms. Do not use this form to update information. 1. Committee Information a. Full Name c. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY IUNI,/ L Mailing Address (include City, State and Zip Code)FINA d. Date Oiled 9108 UNIONVILLE-BRIEF RD MONROE, NC 28110 OCT 9 202110/11/2021 c. Phone Number RECEIVED (704)753-4782 2. Repwit Year I3j Date (mm/dd/yy) 4.IPer%d$dDa1b(umMft7) 15.1YesearerFull Name 10/18/2021 JOHN KIBLER 2021 09/22/2021 6. Type ofComtmdHee FCheck One) 9. of Re checkonly one eo re orYfromone category) ® Candidate Camp tpi ❑ 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 -referendum El Final ❑ Supplemental Final ofFllad (if applicable, check one) 7,11,==.. "Booster Fund" ❑ Building Fund ❑ Pre-nmoff ❑ Third ❑ Annual ❑ Presidential Election Year Candidates Food Semi-annual ❑ Fourth ❑ Special ❑ NC Public Campaign Financing Fmd Cl Mid Year Semi.annual ❑ Year End ❑ Mid Year 10. Special Report Name ❑ Other ❑ ❑ Final Special ❑ Year End (3 Final ❑ Special S. Number of Fundraisers this Re rt 3. Account Information 3. Account Information a. Financial Institution Full Name a. Financial Institution Full Name UWHARRIE BANK b. Purpose c.:%ccount Code b. Purpose c. .account Code CHECKING ACCOUNT FOR CAMPAIGN 228 it. Period Begin Balance it. Period Begin Ralance S S CERTIFICATION I certify that the Committee or Fund is in compliance with all applicable provisions ofArticle 22A, 22B& 22D -22M of Chapter 163 of the NC General Statutes and that no funds are commingled with prohibited or othernondisclosed funds. I furthercertify that this report is complete, true and correct and that 1 have been trained by the NC State Board 10/19/2021 Printed Name of Signer Signature of Appointed Treasurer Date FOR OFFICE USEONLY 1 Date Received: /D 19 a- FirQloyee: Delivery Method ❑ Normal Mail Date Postmarked: Date Scanned: a E ployee,[IRegistered Mail and Delivered ErTp oyee: %gpElectronically Filed Date Data Entered: Fnployee: ❑ Signer has not received mandatory training Please Note: This form cannot be used to amend conartittee information such as the committee address, treasurer, assistant treasurer, custodian of books htfortmation, oraccount information. You must amend the Statement of Organization CRO -2100A- to make committee changes. CRO -1000 NC Slate Board of Elections December 2007 Detailed Summary Amen , s IN No Use this form to summarize all disclosure reoortin2 fonts and to total monetary information 1. Committee Fall Name(and >5mdifapplicable) 2. of Report 3. m Number COMMITTEE TO RE-ELECT PATRICIA HELMS 2021 Pre -Election Start of Election Cycle: January 1, 2021 Reporting Total this Period Total this Hectioo Cycle 4) Cash on Hand at Start $ 1,202.84 1 $ 0.00 RECEIPTS 5) Aggregated Contributions from Individuals 6) Contributions from Individuals 7) Contributions from Political ParlyCommittees 8) Contributions from Other Political Committees 9) Loan Proceeds 0) Refunds/Reimbursements to the Committee 1) Other Receipt Sources Ila) Interest on Bank Accounts IIb)Contributions from Not-For-Pro6tOrganizations I lc) Outside Sources of Income (CRO -1205) (CRO -1210) (CRO -1120) (CRO -1130) (CRO -1410) (CRO -1240) (CRO -1250) (CRO -1250) (CRO -1150) $ 0.00 $ 0.00 $ 1,125.00 $ 3,696.12 $ 300.00 S 350.00 S 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ $ 12.00 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 lld)Legal Expense Fand-OtberSources I le) Exempt Purchase Price Sales (OW -1170) (CRO -1265) $ 0.00 $ 0.00 $ 0.00 S 0.00 2) TOTAL RECDPTS (Add lines 5,6,7,8,9,10,1 Is, I Ib,l le,I Id and I le) $ 1,425.00 S 4,058.12 EXPENDITURES 3) Disbursements 13a) Operating Expenditures 13b) Contributions to Candidates/Political 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) ((20.1320) (CBO -1510) $ 689.64 $ 1,993.80 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0,00 $ 0.00 S 0.00 S 0.00 $ 0.00 $ 126.12 8) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ 689.64 $ 2.119.92 9) Cash on Hand at Fnd (Add lines 4 and 12 together, then subtract line 18) $ 1,938.20 $ 1,938.20 ADDITIONAL INFORMATION 0) Non -Monetary Gifts Given to Other Committees 1) Outstanding Loans (incl. ones from other campaigns) 2) Debts and Obligations osed by the Committee 3) Debts and0bligatioosupedtotdei0ami6ftWNTY -6r>ftiN,�if�PF-FIWAN6E 4) Account Transfers Within the Committee 5) Administrative Support - -ECT-r�i 6)Forgiven LixmRFCFI\/Ff� (CRO -1330) (CR0.1430) (CRO -1610) ((20./620) -- (CRO -1720) (CRO.1710) ((7x -1440) $ $ $ $ $ 0.00 0.00 0.00 0.00 0.00 19 $ 0.00 $ 0.00 $ 0.00 $ 0-00 7) 48 -Hour Notice Reports Sum (CRO -1220) $ 0.00 S 0.00 8) Contributions to be Refunded (CRO -1115) $ 0.00 $ 11MO CRO -1100 NC State Board of Elections .v,""t _ n s Amendment Contributions from Individuals Pg I of 5 ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if foam CRO 1205 is not used 1. Cammilttee F 11 Name aid Aind ifcable Z. ID Namber COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Coitribobw Lfotmwtioa ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments ADMINISTRATIVE ASSISTANT JUDY AMICK 516 RED BARN TRAIL MATTHEWS, NC 28104 (704) 231-0405 c. Employer's Name/Specific Feld WILKERSON ASSOC ARCHITECTS e. Election Sum to Date $ 100.00 f. Prior g. Account Code It. Form of Payment 1. In -Kind Description J. Date (mm/ddlyyyy) k. Amount ❑ 228 Check 10/04/2021 $ 100.00 ❑ g ❑ $ 3. Contributor baformadoa ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) It. Job Title/Profession d. Comments RETIRED TEACHER ANN CANNON 1 135 SMOKE HOUSE DR CHARLOTTE, NC 28270 (704) 849-2970 c. Employer's Name/Specific Feld CHARLOTTE MECKLENBURG SCHOOLS e. Election Sum to Date $ 25.00 E Prior g. Account Code b. Form of Payment I. In -Kind Description j. Date (mm/ddtyyyy) k. Amount ❑ 228 Check 10/04/2021 $ 25.00 ❑ $ ❑ $ 3. Contributor Ilaformatlw ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments DONNA CAROL 3932 FOX RUN SCHOOL CAMPAIGN FINANCE MATTHEWS, NC 28104 OCT 19 2021 (704) 905-8244 ECENED I c Employer's Name/Specific Feld 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 10/06/2021 $ 50.00 ❑ $ ❑ $ 4. Total only this Page $ 175.00 5. Total of ALL CRO -1210 Pages (This line must be online 6 of Derailed Summary Page CFO -1100) $ 1,125.00 CRO -1210 NC State Board of I!Icctions April 2007 Contributions from Individuals Pg 2 of 5 E3 Ye meIs ns N Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Mall Name and Fled if a icabbe 2. m 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 BUSINESS OWNER CAROLYN GORDON 1050 N MAIN STREET MT. PLEASANT, NC 28124 (704) 533-9726 c. Employer's Name/Specific Field GORDON FUNERAL SERVICE e. Flection Sum to Date $ 50.00 f. Prior g. Account Code It. Form of Payment I. In -Wad Description J. Date (mm/dd/yyyy) It. Amount ❑ 228 Check 10/04/2021 $ 50.00 ❑ S ❑ S 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) Is. Job litle/Profession d. Comments RETIRED TEACHER MARGARET GRANGER 124 BECKHAM COURT CHARLOTTE, NC 28211 (704) 365-0822 c. Employees Name/Specific Field CHARLOTTE MECKLENBURG SCHOOLS e. )'lection Sum to Date $ 50.00 1. Prior g. Account ('ode h. Form of Payment i. In -Find Description J. Date(mm/dd/yyyy) It. Amount ❑ „g Check 10/08/2021 $ 50.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state. & zip) b. Job Title/Profession d. Comments CM HARRIS CAMPAIGN FINANCE PO BOX 112 ORLEAN, VA 20128 OCT 19 2021 RECEIVED c. Employer's Name/Specific Field e. Flection Sum to Date $ 50.00 f. Prior g. Accouot Code h. Form of Payment I. 10-10od Description J. Date (mm/dd/yyyy) k. Amount ❑ 228 Credit Card 10/06/2021 $ 50.00 ❑ $ ❑ $ 4. Total only this Page $ 150.00 5. Total of ALL CRO -1210 Pages $ 1,125.00 (This line must be online 6 of Detailed Summary Page CR0.1100) CRO -1210 N( 'tate Board of I'lettion+ Apr112007 Amendment Contributions from Individuals Pg 3 of 5 ❑ Yes IN No Use this formto report individual contributions over $50 or contributions under$50 if form CRO 1205 is not used 1. Committee PWI Name and Pied if cable 2. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor teformation ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) 0. Job Title/Prefession d. Comments SALES RUSSELL HELMS 6259 PARK SOUTH DRIVE CHARLOTTE, NC 28210 (704) 905-8436 c. Employer's Name/Specific Field DESOUTTER TOOL COMPANY e. Election Sum to hate $ 100.00 f. Prior g. Account Code h. Form of Payment I. to -Kind Description J. Date (mm/ddlyyyy) k. Amount ❑ 228 Credit Card 09/30/2021 $ 10000 ❑ $ 3. Contributor luformation ❑ Add ❑ Remit a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job 7itle/Pmfession d. Comments RETIRED POLICE GARTHLIA JOHNSON 417 ANNABERG LANE MONROE, NC 28110 (704) 698-2602 e. Flaployer's Name/Specific Field CMPD e. Flection Sum to Date $ 100.00 E Prior g. Account Code h. Form of Payment I. In -Kind Description j. Date (mm/ddlyyyy) It. Amount ❑ 228 Check 10/08/2021 $ 100.00 ❑ $ ❑ $ 3. Contributor hillbramtfan ❑ Add ❑ Remove a. Full Name, Mailing Address & Phoneb. (include city, state, & zip) UNION COUN NCE Job Title/Profession d. Comments RETIRED MEDIA SPECIALIST h4 4phjam JUDYJOHNSON 1230 FOREST BLUFF DR OCT 19 2021 MIDLAND, NC 28107 (704) 575-1288 RECEIVED a Employer's Nome/Specific Field CHARLOTTE MECKLENBURG SCHOOLS c. Election Sum to Date $ 25.00 f. Prior It. Account Code It. Form of Payment i. In -]God Description j. Date (mm/dd/yyyy) k. Amount 13 228 Cash 10/01/2021 g 25.00 ❑ $ ❑ S 4. Total only this Page e _ $ 225.00 5. Total of ALL CRO -1210 Pages ,. =- - - - --- - = - -- --- $ 1,125.00 (This line must be online 6 of Detailed Summary Page CaO-1100) CRO -1210 1,t- flute Ruard nt 1 -lection, April 2007 Amendment Contributions from Individuals Pg 4 or 5 ❑ Yea IN No Use this forth to report individual contributions over $50 or contributions under $50 if form CRO 1205 is refused 1. Committee Fbll Name and Flood if applicable) Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Ntailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments RETIRED TEACHER JOYCE A NEWTON 3700 TAYLOR GLEN LANE NW APT 262-0 CONCORD, NC 28027 (704) 537-5038 c. Employer's Name/Specific Field CHARLOTTE MECKLENBURG SCHOOLS e- Election Sum to Date $ 50.00 E Prior g. Account Code b. Form of Payment 1. to -Kind Description I. Date (mm/dd/yyyy) k. Amount ❑ 228 Check 09/29/2021 $ 50.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b..lob lisle/Profession d. Comments RETIRED TEACHER ANN H PRICE 10105 INDIAN TRAIL-FAIRVIEW ROAD INDIAN TRAIL, NC 28079 (704) 622-7175 c. Employer's Name/Specific Field UNION COUNTY PUBLIC SCHOOLS e. Election Sum to Date $ 100.00 L Prior g. Account Code b. Form of Payment i. In-kind Description j. Date (mm/ddlyyyy) k. Amount ❑ 228 Check 09/29/2021 $ 100.00 ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name. %tailing Address & Phone (include cit), state, & zip) 1V b. Job litle/Profession d. Comments SERGEANT BRADLEY PURSERUNiu1GN FINANC 210 OLD DUTCH ROAD Wg P^ INDIAN TRAIL, NC 28079 OC� 19 202 \ Ir E1 V G� a Employer's Name/SpecificField UNION COUNTY SHERIFFS OFFICE e. flection Sum to Date $ 100.00 f. Prior g. Account Code h. Form o ayment 1. to -Mod Description J. Date (mm/ddlyyyy) k. Amount ❑ 228 Credit Card 10/08/2021 $ 100.00 ❑ $ ❑ $ 4. Total only this Page $ 250.00 5. Total of ALL CRO -1210 Pages (This line must be on line 6 of Detailed Summary Page CRO -1100) $ 1,125.00 CRO -1210 At V,itc K,drd Ell F Icclinns April 2007 Awesdmeat Contributions from Individuals Pg 5 of 5 I❑ Yes ® No Use this form to report individual contributions over $50 or contributions under S50 if form CRO 1205 is not used 1. Committee FW I Nam and Feed if cede 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 ATTORNEY JOHN SESTITO 900 CROOKED RIVER DRIVE WAXHAW, NC 28173 (513)910-6768 e. Employer's Name/Specifrc Feld CENTERS FOR DISEASE CONTROL (CDC) e. Election Sum to Date $ 10000 f. Prior g. Account Code h. Form of Payment i. In -Mad Derieriptioa i. Date (mm/dd/yyyy) k. Amount ❑ 228 Check 09/30/2021 $ (00.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name. )tailing Address & Phone (include city, state, & zip) b. Job Lille/Profession d. Comments OWNER GALESMALL 5716 POLK MOUNTAIN DRIVE MARSHVILLE,NC 28103 (704)283-7807 c. Employers Name/Specific Field SKYWAY TIRE e. Flection Sum to Date S 200.00 E Prior g. Account ( ode h. Form of Payment i.In-Kind Description j. Dale (mm/ddlyyyy) k. Amount ❑ R Check 09/24/2021 S 200.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name. Mailing \ddress&Phone (include cit), slate, & zip) b. Job Title/Profession d. Comments UNEMPLOYED SARAH TALLEY 4141 GREENMEAD ROAD WINSTON-SALEM, NC 27106 (336) 408-8644 c. Employees Name/Specific Field UNEMPLOYED e. Election Sum to Date $ 25.00 f. Prior g. Account Code h. Form of Payment I. In-Kiad Description I. Date (mm/dd/yyyy) k. Amount ❑ 228 Credit Card UNION COUNTY 09/24/2021 $ 25.00 ❑ r FZ $ 4. Total only this Page $ 325.00 5. Total of ALL CRO -1210 Pages (This line mast be on fine 6 ojDefa(led Summary Page CR41100) $ 1,125.00 CRO -1210 NC State Board of Flections April 2007 amcndm ent Contributions from Political Party Committees Pg I ..f ! ❑ ,es ® No Use this form to report contributions from a political party 1. Co®itlee PWI Name and Fund ifapplicable) COMMITTEE TO RE-ELECT PATRICIA IiELMS KINDLEY 2. ID NumberAN 3. Contributor Information ❑ Add ❑ Remove qwr— a. Full .Name, Mailing Address & Phone (include city, state, & zip) h. Comments UNION COUNTY DEMOCRATIC COMMITTEE (UNION DEC) PO BOX 81 MONROE, NC 28111 (704) 458-6380 c. Flection Sum to Date S 100.00 d. Account Code e. Form of Payment f. In -land Description It. Date (mm/dd/yyyy) h. Amount 228 Check 09/28/2021 a 100.00 s s 3. Contributor information ❑ Add ❑ Remove a. Full Name, flailing Address & Phone (include city, state, & zip) b. Comments UNION DEMOCRATIC WOMEN (UNION DW) 7905 TOTTENHAM COURT WAXHAW,NC 28173 c. Bectlon Sum to Date S 200.00 d. Account Code e. Form of Payment L In-kind Description g. Date (mm/ddlyyyy) It. Amount x Check 10/08/2021 S 200.00 a a 4. Total only this Page S 300.00 5. Total of ALL CRO -1220 Pages (This line must be on line 7 of Delalled Summary Page CRO -1100) $ 300.00 CRO -1220 CAMPA GNO COUNTY OCT I9 2021 RECEIVED %( Rls.a Ro,.rdot 11CCNon. April 2007 'Ameadmea[ Disbursements Pg I of 5 `❑ 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 FWI Name and Fund if applicable) ❑ Add ❑ Remove 2. m N01mr COMMITTFE TO RE-ELECT PATRICIA HELMS KINDLEY b. Coordinated Committee Name 3. Type of bis batsement (Please use separate CRO -1310 forams for each tune of Disbursement.) Operating Expenxs CbntriMniun. to Can didaterl'nlit ical CommitteesLj Coordinated Parts ICzpcndtmes 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) Federal Comity: ❑ State ❑ Mmicipality: b. Coordinated Committee Name d. Comments $ 75.97 f. Account Code AMAZON CORP 410 TERRY DRIVE N. SEATTLE, WA 81226 (206) 266-1000 b. Purpose Code G Level Registered (Specify) 0 Federal Cotmty: ❑ State ❑ Mmticipality: e. Flection Sum to Date 228 $ 75.97 f. :tecuunt Code g. Form of Pas me nt h. Purpose Code i. Date (mm/ddlyyyy) j. Amount 1k. Required Remarks I IS Debit ('aid Is 09/29/2021 $ I5.15 CANDY FOR '_'x Debit Card b. Coordinated Committee Name 09/29/2021 $ 16.00 INLLU W CC IN 4, Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments AMAZON CORP 410 TERRY DRIVE N. SEATTLE, WA 81226 (206) 266-,1000 c. Level Registered (Specify) Federal Comity: ❑ State ❑ Mmicipality: e. Flection Sum to Date $ 75.97 f. Account Code Ig. Form of Payment b. Purpose Code I. hate (mm/dd/yyyy) 1j. Amount 11s. Required Remarks 228 Debit Card C 10/10/2021 1 $ 44.82 LIGHTS TO DECORATE Is run FUND RAISET-- 4. Payee Information ❑ Add ❑ Remove a. Full Nacre, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments AUSTIN PRINTING COMPANY U, 11, " 1823 MORGAN MILL RD CANIPAIGN FINAN'. MONROE, NC 28110 T (704) 289-1445 �C 19 NP c. Level Registered (Specify) Federal 13 County: ❑ State Q Mtmieipality: e. Flection tium to Date I $ 320.25 LAccount Code g. Form of Ps)men :Pu se .ode ji. Date (mm/ddlyyyy) j. Amount Its. Required Remarks 228 Debit Card B 09/29/2021 $ 320.25 1 CAMPAIGN LITERATURE Is 1 5. Total only this Page $ 396.22 6. Total of ALL C110-1310 Pages (This line goes in line 13a of Detailed Summar, Page CRO -1100 if Operating Frpenses) (This line goes in line 13hof Detailed Summon Page CRO -1100 ifCantrib to Candidateo'Political Comm) (This line goes in line 13c of Detailed Summar, Page CRO -1100 if Coordinated Part), Erpendimres) $ 689.64 7. Purpose Codes (List detafled expenditure code in (h.) above) ` A* - Media B* - Printing C* - Fundraising D- To Another Candidate E - Salaries F* - Equipment C - 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 re uiredremarks field(k) CRO -1310 NC gate board of Elections December 2009 Ameadmeut Disbursements Pg 2 of 5 ❑ Yee ® No Use this fonnto report expenditures fromthe conatattee for operating expenses, contributions to candidate/political committees and coordinated Party expenditures 1. Committee FLIT Name and Fund if applicable) COMMITTEE TO RE-ELECT PAT RICIA HELMS KINDLEY 2. m Number 3. Type of Disbursement (Please ase separate CRO4310 fonat for each type ofDisbwseme") Operating Expenses Contributions to Candidates'I'oluical Committees Coordinated Party Fxpendittaes 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated ('ommittee Name d. Comments DOLLAR TREE LOCUST, NC 11652 RED BRIDGE RD LOCUST, NC (980) 907-4037 c. Level Registered (Specify) U Federal 13 County: ❑ tiate ❑ Municipality: e. Election Sum to Data $ 4.08 f. :Account Code g. Form of Payment 1h. Purpose Code If. Date (mm/ddlyyyy) J. Amount 1k. Required Remarks _28 Debit Card O 10/01/2021 $ 4.08 1 BOTTLED WATER FOR 5 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b.(oordinated C ommittee Name d.Comments DONORBOX.ORG (REBEL IDEALIST) 2615 COLUMBIA PIKE #427 ARLINGTON, VA 22204 e. Level Registered (Specify) L3 Federal 13 Comity: ❑ State ❑ Municipality: t. Election Sum to hate $ 1S.31 L Account Code g. Form of PaYment h. Purpose Code i. Date(mm/d&yyyy) J. Amount k. Required Remarks 228 Dralt f t 09/24/2021 $ 0.38 1 APPLICATION FEE 228 Droll O 09'30/2021 $ 1.50 APPLICATION FEE 4. Payee Information ❑ Add ❑ Remove a. Full Nance, Mailing Address & Phone include cit, state. &zi b. Coordinated Committee Name d.Comments DONORBOX.ORG (REBEL IDEALIST) 2615 COLUMBIA PIKE 1 9 ZQ�' 1(427 ARLINGTON, VA 22204 r -NE1 c. Level Registered (Specify) [] Federal County: 13state [3 Municipality: e. Election Sum to Date $ 18.54 .Aecuuut Code g. Form of Payment h. Purpose Code i. Date(mm/dd/yyyy) J.Amosat 1k. Required Remarks 228 Draft O 10/06/2021 $ 0.75 APPLICATION FEE 228 Wall O 1006/2021 $ 0.75 1 APPLICATION FEE 5. Total only this Page $ 7.46 6. Total of ALL CRO -1310 Pages (This line gars in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) $ 689.64 (This line goes in line 13b of Detailed Summary Page CRO -1100 ifConvib to Candidates/Poliseal Comm) (7his line goes in line 13c afDetailed Summary Page CRO -1100 if Coordinated Parry• Eapendimres) 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 CR 0.13 / 0 N( Sate Board of I Ica ions December 2009 Amendment Disbursements Pg 3 of 5 ❑Yes ® No Use this fonnto report expenditures fiomthe committee for operating expenses, contributions to candidate/political comunittees and coordinated party expenditures 1. Committee Full Name and Fund if applicade 2. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. of Disbarsemeat (Please use seaamte CR&1310 fomes for each tune ofDisbursensent.) Operating Fapenscs Con t ritxa ions it)Can didates'PoI it ical Coin in it t ees Coordinated Part c I e pen dlttae5 4. Payee Information ❑ Add ❑ Remove a. Full Narne, Mailing Address & Phone include city, state, & si b. Coordinated Committee Name d. Comments DONORBOX.ORG (REBEL IDEALIST) 2615 COLUMBIA PIKE #427 ARLINGTON, VA 22204 c. Level Registered (Specify) L3Federal 0 County: ❑ State ❑ Municipality: *.Election Sum to Date $ 18.54 C Account( ode g. Form of Payment h. Purpose Code 1. Date (musidd/yyyy) J. Amount 11k. Required Remarks 118 Drub O 10/08/2021 $ 1.50 DONORBOX 4. Payee Information ❑ Add ❑ Remove a. Full Nacre, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments ETSY.COM 55 WASHINGTON STREET SUITE 512 BROOKLYN, NY 11201 (718) 855-7955 c. Level Registered (Specify) Ll Federal County: ❑ state ❑ Municipality: e. Election Sam to Date $ 32.69 L Account Code g. Form of Payment h. Purpose Code ji. Date (mm/dd/yyyy) j. Amount 1k. Required Remarks 228 Debit Card O 10/18/2021 $ 32.69 THANK YOU CARDS TO 4. Payee Information ❑ Add ❑ Remove a. Full Nance, Mailing Address & Phone (include city, state, & zip)'i b. Coordinated Committee Name it. Comments FOOD LION LOCUST, NC ,_ ; J FINAN ' 1004 MAIN ST - LOCUST, NC 28097-9774 OLj 9 ZO2 (704) 888-6660E3 Ear°\1F,tann a Level Registered (Specify) Federal 0 County: State [3Municipality: e. Election Sum to Date 4.04 L Account Code g. Form of Psymeat h. Purpose Code i. Date (mm/dd/yyyy) j. Amount 1k. Required Remarks 228 Debit Card CO 10/01/2021 $ 4.04 BOTTLED WATER FOR 5. Total only this Page S 38.23 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Bspenses) $ 68964 (This line goes in line lab of Detailed Summary Page CRO -I /00 ifContrib to Candidates/PoRRcal Comm) (This line goes in line 13c of Detailed Summon, Page CRO -I 100 if Coordinated Parry Fcpendltures) 7. Purpose Codes (List detailed expenditure code in (h.) above) A* - Media R* - Printing C* - Fundraising D- To Another Candidate E - Salaries F* - FAuiprnent G - Political Party H* - Holding Pudic Office Expenses I - Postage d - Pcnab ie> K* - Office Expenses Q* - Donation to legal Expense Fund O* Other * Codes re uire detailed explanation in required reviarks field ( RO43/0 NC 4ate 14,)ard of I lections December 2009 Amendment Disbursements Pg 4 of 5 i❑ 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 Fail Name and Fund if a icable COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 2. FD 3. ofDiabunementfPleawwesenaroteCRO-1310forts/oreachtvneofDisbursereent.) Operating Expenses Ll Contritsa ions to Candidates Political Committees Lj COPrdlnatcd Parte I[zpenditues 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated ( ommittee Name d. Comments KRISTA KINDLEY MARTIN 4973 FOLLANSBEE ROAD WINSTON SALEM, NC 27127 (336) 793-7987 a Level Registered (Specify) U Federal 0 County: ❑ State ❑ Municipality: *.Election Sem to Date $ 63.66 L Account Code g. Form of Payment h. Purpose Code I. Date (mm/ddtyyyy) j. Amount it. Required Remarks 228 ('heck (' 10/02/2021 $ 63.66 PURCHSED NAME TAGS, $PhNN, PAPEK. 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Cam ments STRIPE CORPORATON 185 BERRY ST SUITE 550 SAN FRANCISCO, CA 94107 (650)427-9276 c. Level Registered (Specify) Federal EJ County: ❑ State ❑ Municipality: e. Election sum to Date S L Account Code g. Form of Payment k. Purpose Code ji. Date (mm/ddlyyyy) j. Amount it. Required Remarks 228 Draft O 09/24/2021 $ 1.03 1 PROCESSING FEE 228 Draft O 0910/2021 $ 3.20 1 PROCESSING FEE 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) It. ('aordinated Committee Name d. Comments STRIPE CORPORATON 185 BERRY ST - SUITE 550 pCT �9 202i SAN FRANCISCO, CA 94107 (650) 427-9276 r F c. Level Registered (Specify) Federal 0 County: ❑ state ❑ Municipality: e. Election sum to Date $ 41.55 f. Account Code g. Form of Pa_vme nt It. Purpose Code i. Date (in m/dd/yyyy) J. Amount 1k. Required Remarks 228 Oraft 10/06/2021 $ 1.75 PROCESSING FEE 228 Draft n 10./06/2021 S 1.75 PROCESSING FEE 5. Total only this Page S 71.39 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CRO -1100 iiOpemting Expenses) (This fine goes in line lab of Detailed Summary Page CRO -1100 iJConnib to CandidatesTolifical Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 iifCoordinated Parry, £vpendimres) $ 689.64 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 - 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 gate Board of lilections December 2009 Amendment Disbursements Pg 5 of 5 ❑ Yea IN No Use this forrnto report expenditures from the committee for operating expenses, contributions to candidate/politicaI committees and coordinated party expenditures 1. Committee Full Name and Fund if applicable) $ 176.34 COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3.oflMshuraement (Please use separate CRO-1310forarr for each fvneofDisbursement.) Operative Ezpcn �s U C'ontrilxnionsto Candidates'Politica[ Committees Coordinated Park 1Apendit ures 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) It. Coordinated Committee Name d. ('omments 7. Purpose Codes (List detailed expenditure code in (h.) above) A* - Media B* - Printing C* - Fundraising D- To Another Candidate STRIPE CORPORATON 185 BERRY ST SUITE 550 SAN FRANCISCO, CA 94107 (650)427-9276 a Level Registered (Specify) Federal 13 Comfy: ❑ State ❑ Municipality: e. Flection Sum to Date $ 11.5 E Aceoant Code g. Form of Payment h. Purpose Code ji.Date (mm/ddlyyyy) j. Amount k. Required Remarks 228 Draft O 10/08/2021 $ 3.20 1 PROCESSING FFF_ S 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, At zip) b. ( oordinated Committee Name d. Com me n is UNITED STATES POSTAL SERVICE (USPS) MONROE, NC 101 S CHARLOTTE AVE MONROE,NC 28112 (704) 289.4508 c. lAwl Registered (Specify) U Federal 13 Comfy: ❑ State ❑ Municipality: e. Flection Sum to Date $ 143?0 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks 228 Debit Card I 09/30/2021 $ 120.00 228 Debit Card I 10/08/2021 S 23.20 4. Payee Information ❑ Add ❑ Remove a. Full Name, \tailing .Address & Phone include city, state & zi '- - b. Coordinated Committee Name d. Comments WALMART 1876 W MAIN STOCT 19 2021 LOCUST, NC 28097 (704) 781-0426 n E ^ ly IVr D t^ 11 V G c. Level Registered (Specify) U Federal U County: ❑ State ❑ Municipality: e. Rection Sam to Date $ 29.94 f. Account Code Ig. Form of Payment 1h. Purpose ('ods 1j. Date (mm/ddiyyyy)jj.Amount 1k. Required Remarks 228 Debit Card a 10/01/2021 IS 17.19 NAME TAGS & GEL PENS 228 Debit Card 10/05/2021 S 12.75 1 fVftkT6FRFS TO IaNL`IaJ N 5. Total only this Page $ 176.34 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CRO -1100 ifoperaang Expenses) $ 689.64 (This line goes in line 136 of Detailed Summary Page CRO -1100 ifConMb to CandidatesiPolitical Comm) (This fine goes in line 13c of Detailed .Summary 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 Pudic Office Expenses I - Postage .1 - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* Other * Codes require detailed explanation in re uiredremarks field(k) CRO -1310 NC State Board of Flections Uccember 2009