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Kindley,Patricia_2021-35-Day-Report-amendAmea rt Disclosure Report Cover ® Yeses❑ No Use this fonnfor general report and committee information, must be signed and submitted along with other detailed forts. Do not use this form to update information. 1. Committee Information a. Full Name c ID \umber COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLLti' It. Mailing Address (include City, State and Zip Code) d. Date Filed 9108 UNIONVILLE-BRIEF RD MONROE, NC 28110 01/06/2022 c. Phone Naber (704)753-4782 2. Report Year 13. Period Start Date (mm/dd/yy) 4. Period End Date (mm/ddtyy) T5. Treasurer Full Name 2021 07 01 2021 09/21/2021 JOHN KIBLER 6. Type of Com®ttee Check One) 9. Type of Report check only one type Ofmetion from one tate o ® Candidate Campaign ❑ Party Municipal State/County Referendum ❑ Joint Fundraiser ❑ PAC ❑ Organizational ❑ Organizational ❑ Organizational ❑ Referendurn Legal Expense Fund ® ❑ ❑ Thirty-five day Pre-primary Pre-election Quarterly ❑ First ❑ Second ❑ Pre -referendum ❑ Final ❑ Supplemental Final 7. Type of find ffapphcabte. check one) ❑ "Booster Fund" ❑ Building Fuld ❑ Pre -runoff ❑ Third ❑ Annual ❑ Presidential Election Year Candidates Fund Semi-annual ❑ Fourth ❑ Special ❑ NC Public Campaign Financing Food ❑ Mid Year Semi-annual ❑ Year End ❑ Mid Yew 10. Special Repwill Name ❑ Other: ❑ ❑ final special ❑ Yew End [3Final ❑ special UNION COI. CAMPAIGN FF t 8. Number of Fundraisers!nA 3. Account Information 3. Account Information _ a. Financial Institution Full Name a. Financial Institution Full Name UWHARRIE BANK b. Purpose c Account Code It. Purpose c. Account Code CHECKING ACCOUNT 219 FOR CAMPAIGN d. Period Begin Balance 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 arecommingled with prohibited or other non -disclosed funds. I further certify that this report is complete, true and orrect anted that 1 have been trained by the NC State Board '1'14/Y , itJ 01/10/2022 Printed Name of Signer Signature of Appointed -I reasurer Date FOR OFFICE tSEONLY Date Received:Employ �— Delivery Method ❑ Nomal Mail Date Postmarked: Btered Mail Employee: �❑ is Hand Delivered Date Scanned: Employee: ❑ Electronically Filed Date Data Entered: Employee: ❑ Signerhas not received mandatory training Please Note: This form cannot be used to amend committee infommation such as the committee address, treasurer, assistant treasurer, custodian of books information, oraccount information. You must amend the Statement of Organization CRO -2100A- to make committee changes. CR04000 NC Sate Board of Elections December 2007 %m e n dm en Detailed Summary ® , e, ❑ N„ Use this form to sunmarize all disclosure reoortin¢ fonts and to total monetary information 1. Committee Full Name and Fund if 'cable 2. Type of Report 3. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS 2021 Thirty -five-day Start of Election Cycle: January 1, 2021 Total this Re rtin Period I„tai this Election Cycle 4) Cash on Hand at Start $ 0.00 $ 0.00 RECEIPTS 5) Aggregated Contributions from Individuals 6) Contributions from Individuals 7) Contributions from Political PartyCommittees 8) Contributions from Other Political Committees 9) Luau Proceeds 0) Refunds/Reimbursements to the Committee 1) Other Receipt Sources Ila) Interest on Bank Accounts 11 b) Contributions from Not -For -Profit Organizations I lc) Outside Sources of Income IId) Legal Expense Fund -Other Sources I le) Exempt Purchase Price Sales (CRO -1205) (CRO -1210) (CRO -1120) (CRO -1230) (CRO -1410) (CRO -1240) (CRO -1250) (CRO -1250) (CRO -1150) (CRO -7270) (CRO -1265) $ 840.00 $ 840.00 $ 1,731.12 $ 1,731.12 $ 50.00 $ 50.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 12.00 $ 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 5,6,7,8,9,10,1 lal lb,l lc l Id and l le) $ 2,633.12 S 2,633.12 EXPENDITURES 3) Disbursements 13a) Operating Expenditures 13b) Contributions to Candidates/Political Committees 13c) Coordinated Party Expenditures 4) Aggregated Non-MedinExpenditures 5) Loan Repayments 6) Refuads/Reimbursements from the Committee 7) In-IGndContributions (CRO -1310) (CRO -13101 (CRO -1310) (CRO -1315) (CRO -1420) (CRO -1320) (CRO -1510) $ 1,147.88 $ 1,147.88 $ 0,00 S 0.00 $ 0.00 $ 0.00 $ 156.28 S 156.28 $ 0.00 $ 0.00 S 0.00 $ 0.00 $ 126.12 $ 126.12 8) TOTAL EXPENDrI'URES (Add lines I3a, 13b, 13c, 14, 15, 16 and 17) $ 1,430.28 $ 11430.28 9) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18) $ 1,202.84 $ 1,202.84 ADDITIONAL INFORMATION 0) Non -Monetary Gifts Given to Other Committees 1) Outstanding Loans (incl. ones from other campaigns) Debts and Obligations owed by the Committee Debts and Obligations owed to the Committee [3) 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) (CRO -1440) (CRO -2120) $ $ $ $ S 0.00 0.00 0.00 0.00 0.00 S 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 g) Contributions to be Refunded (CRO -1215) $ 0.00 $ 0.00 CRO -1100 NC State Board of Elections August 2008 amendment Aggregated Contributions from Individuals Page or ! ® les ❑ No Optional form used to report NC Contributions From Individuals of $50 or less 1. Committee Fall Name mW Flmd ifa ieable 2. In Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY . Contributor Information a. Amend b. Account Code e.Form of Payment d. In -Kind Description e. Date (mm/dd/vyyy) f. Amount Add ❑ Remove 228 Check 09/20/2021 $ 25.00 Add ❑ Remove 228 Check 08/30/2021 $ 20.00 Add ❑ Remove 228 Check 09/01/2021 $ 50.00 Add ❑ Remove 228 Credit Card 09/01/2021 $ 50.00 Add ❑ Remove 228 Check 09/10/2021 $ 50.00 rT Add ❑ Remove 228 Cash 08/26/2021 $ 20.00 Add 13 Remove 228 Cash 09/17/2021 S 50.00 Add 228 Credit Card 09/07/2021 $ 20.00 ❑ Remove Add ❑ Remove 228 Check 08/16/2021 S 25.00 Add ❑ Remove 228 Check 09/17/2021 S 50.00 Add 228 Credit Card 09/01/2021 $ 50.00 13 Remove Add ❑ Remove 228 Credit Card 09/16/2021 S 50.00 Add ❑ Remove 228 Check 09/02/2021 $ 25.00 =Add 228 Credit Card 09/16/2021 $ 25.00 ❑ Remove Add ❑ Remove 228 Check 08/30/2021 $ 25.00 Add 228 Credit Card 09/02/2021 $ 50.00 13 Remove Add 228 Check 09/03/2021 S 50.00 ❑ Remove Add 228 Check 08/16/2021 S 30.00 ❑ Remove Add 228 Check 08/30/2021 S 50.00 13 Remove Add 228 Credit Card 09/01/2021 $ 50.00 ❑ Remove Add 228 Check 09/20/2021 $ 25.00 ❑ Remove Add 228 Credit Card 09/09/2021 $ 50.00 ❑ Remove 4. Total only this Page $ $840.00 5. Total of ALL CRO -1205 Pages $ $840.00 (TM$ Mae mast be on Une 5 gfDewUed Summary Page CRO -1100) CRO -1105 NC State Board of Elections April 2007 Amendment Contributions from Individuals Pg I of 6 ® lies ❑ No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Cound toe FoIl Nam and Fund if a cable 2. ID Number COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contribute Information ❑ Add ❑ Rerrove a. Full Name, Mailing Address & Phone (include city, state, & zip) It. Job Title/Profession d. Comments DENTAL EQUIPMENT SALES JOHN T BELK 209 WEST HWY 218 MONROE, NC 28110 (704) 753-1829 c. Finployer's Name/Specific Field SELF e. Election Sum to Date $ 100.00 f. Prior g. Account Code It. Form of Payment L In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 228 Check 09/21/2021 $ 100.00 ❑ $ ❑ $ 3. Contributor baforumdoo ❑ Add ❑ =ve a. Full Name, Mailing Address & Phone (include city, state, & zip) It. Job 7ille/Profession d. Comments RETIRED SECRET SERVICE AGENT WILLIAM G CREEL 4703 TOWNSHIP WALK MERIETTA, GA 30066 c. Fmployer's Name/Specific Feld US FEDERAL GOVERNMENT e. Election Sum to Date $ 200.00 f. Prior g. Account Code It. Form of Payment I. In -Kind Description j. Date (mm/ddlyyyy) it. Amount 11 228 Check 08/27/2021 $ 200.00 ❑ $ ❑ $ 3. Contributor Informadon ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) It. Job Trtle/Profession d. Comments RETIRED RN KATHLEEN DOMANSKI 3714 BANYAN WAY WAXHAW, NC 28173 (704) 6184116 c. Employer's Name/Specific Field UNION ATRIUM e. Election Sum to Date $ 100.00 E Prior g. Account Code It. Form of Payment i. In -Kind Description J. Date (mm/dd/yyyy) k. Amount ❑ 228 Credit Card 09/21/2021 $ 100.00 ❑ $ ❑ $ 4. Total only this Page $ 400.00 5. Total of ALL CRO -1210 Pages (This line must be online 6 of Detailed Summary Page CRO -1100) $ I ,731.12 CROL1210 NC Aatc Nerdof I lection, April 2007 Amendment Contributions from Individuals Pg 2 or 6 ® les ❑ No Use this form to report individual contributions over $50 or contributions under$50 if form CRO 1205 is not used 1.CammifleeFWIName(and Fnudifapplicable) 2.IDNruber COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor InfornmNon ❑ Add ❑ Remove a. Full Name. Mailing Address & Phone (include city, state, & zip) b. Job litle/Profession d. Comments RETIRED TEACHER KAY EWARDS 9108 UNIONVILLE BRIEF ROAD MONROE, NC 28110 (704) 753-4782 c. Employer's Name/Specific Field UNION COUNTY PUBLIC SCHOOLS e. Flection Sum to Date $ 60.00 f. Prior g. Account Code h. Form of Payment i. In-IGnd Description I. Date (mm/ddlyyyy) k. Amount ❑ 228 Check 07/29/2021 $ 50.00 0 228 Cash 09/02/2021 $ 10.00 ❑ $ 3. Contributor Information ❑ Add ❑ Retrieve a. Full Name, flailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments CORPORATE OFFICER ALICE HABBAL 1416 EAST BRIEF RD MONROE, NC 28110 (704) 7534855 c. Employer's Name/Specific Field VISION OFFICE SYSTEMS e. Flection Sum to Date $ 100.00 I. Prior g. Account Code b. Form of Payment I. In-IGnd Description j. Date (mm/dd/yyyy) It. Amount 13 228 Check 07/29/2021 $ 100.00 ❑ $ ❑ $ 3. Contributor loformadon ❑ Add ❑ Reiftove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession 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 L Prior g. Account Code h. Form of Payment i. In-IGnd Description j. Date (mm/ddlyyyy) Is. Amount ❑ 228 Check 08/27/2021 $ 100.00 ❑ $ ❑ $ 4. Total only this Page $ 260.00 5. Total of ALL CRO -1210 Pages (This line must he online 6 ojDetailed Summary Page CRO -1100) $ 1,731.12 CRO -1210 NC Vine Rn and o f I ilecGun z April 2007 Amendment Contributions from Individuals Pg 3 of 6 ® les ❑ No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Flat]Nmme(AW Flandifa icable 2.IDNumber COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ RernDve a. Full Name, Mailing Address & Phone (include city, state, & zip) Is. Job7itle/Profession d. Comments RETIRED INTERIOR DESIGNER RUTH HELMS 2201 MELODY DR MONROE, NC 28110 (704) 289-5358 c. Employer's Name/Specific Field SELF e. Election Sum to Date $ 100.00 f. Prior g. Account Code It. Form of Payment i. Io-IGod Description I. Date (mmlddlyyyy) k. Amount ❑ 228 Check 08/16/2021 $ 100.00 ❑ $ ❑ 5 3. Contributor Information ❑ Add ❑ Remove a. Full Same, 'flailing Address & Phone (include city, state, & zip) b. Job7itle/Profession d. Comments RETIRED ENGINEER JOHN KIBLER 3614 S ROCKY RIVER RD MONROE, NC 28112 (704) 210-3087 c. Employers Name/Specific Field WANG LABORATORIES, DUKE ENGINEERING & SERVICES e. Election Sum to Date $ 95.00 . Prior s. Account Code h.Formof Payment i.ln-kind Description j. Date(mm/dd/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 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) It. Job Title/Profession d. Comments ADMINISTRATIVE SPECIALIST DEAN KINDLEY 1434 MITCHELL AVE TALLAHASSEE, FL 32303 (850) 688-3393 e. Employers Name/Specific Field CITY OF TALLAHASSEE FLORIDA e. Election Sum to Date $ 100.00 E Prior g. Account Code It. Form of Payment L In -Mod Description I. Date (mm/dd/yyyy) it. Amount 11 228 Check 08/30/2021 $ 100.00 ❑ $ ❑ $ 4. Total only this Page $ 295.00 5. Total of ALL CRO -1210 Pages (This Une must bean One 6 ojDetaffed Summary Page CRO -1100) $ 1,731.12 CRO -1110 NC Statc Board of Elections Aprd 2007 Amendment Contributions from Individuals Pg 4 or 6 ® ves ❑ No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Calodthee FWI Name and Flied 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) Is. Job Iitle/Profession d. Comments MENTAL HEALTH PROFESSIONAL MICHAEL LANGE 3895 VALINDA DR WINSTON SALEM, NC 27106 (336) 815-8823 e. Employer's Naae/Speeiee Field CARDINAL INNOVATIONS e. Election Sum to Date $ 100M0 E Prior Ig. account Code Is. Form of Payment t. In -Kind Description J. Date (mm/dd/yyyy) k. Amount ❑ 228 Check 08/27/2021 $ 100.00 ❑ $ ❑ 5 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. .lob Title/Profession d. Comments CLINICAL SOCIAL WORKER KARA LEMON 1204 STEVENS RD MONROE, NC 28110 (704) 242-4322 c. Employees Name/Specific Feld THERAPEUTIC ALTERNATIVES e. Flection Sum to Date $ 100.00 C Prior g. Account Code h. Fora of Payment i. la-Kiad Description J. Date (mm/ddfyyyy) It. Amount ❑ 228 Check 08/16/2021 $ 100.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, At 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. Fmployer's Name/Specific Field UNC SCHOOL OF SOCIAL WORK e. Election Sum to Date $ 126.12 f. Prior g. Account Code It. Form of Payment i. in -Kind Description J. Date (mm/ddlyyyy) k. Amount ❑ 228 In -Kind BANNERS ON THE CHEAP ORDER NUMBER 09/09/2021 $ 126.12 4. Total only this Page $ 326.12 5. Total of ALL CRO -1210 Pages (This line must be online 6 oJDetailed Summary Page CRO -1100) $ 1'731.12 CRO -1210 NC State Board of Elections ApriI2007 Amendment Contributions from Individuals Pg s of 6 ® Yea ❑ No Use this formto report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1.ComadUseFall Name(mod l?Itrdifa icable 2.IDNrmtier 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 TEACHER LORNA PRICE 630E HIGHWAY 218 MONROE, NC 28110 (704) 989-1685 c. Employer's Name/Speclfle Field UNION COUNTY PUBLIC SCHOOLS UCPS e. Election Sum to Date $ 100.00 f. Prior g. Account Code h. Form of Payment I. la -Kind Description ). Date (mm/dd/yyyy) k. Amount ❑ 228 Check 09/10/2021 $ 10000 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job iitle/Profession d. Comments VETERINARIAN CLAUDIA SANDOVAL 2508 EAST 7TH STREET CHARLOTTE, NC 28204 (704) 993-6854 c. Elsployer'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 (mm/dd/yyyy) Is. Amount ❑ 229 r d:i C';ird 09/15/2021 $ 100.00 Cl $ ❑ $ 3. Contributor Information ❑ Add ❑ Rernove a. Full Name, :Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments DISTRICT RECREATION STAFF OFFICER THERESA SAVERY 5401 OLIVIA COURT MARSHVQLLE, NC 28103 (303) 859-2795 c. Employers 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 I. Date (mm/dd/yyyy) k. Amount ❑ 228 Credit Card 09/15/2021 $ 100.00 ❑ S 4. Total only this Page $ 300.00 5. Total of ALL CRO -1210 Pages (This line must be online 6 ojDetalled Summary Page CRO -1100)$ 1,731.12 CRO -1210 NC Si atc &)ard oC Elections April 2007 Amendment Contributions from Individuals Pg 6 of 6 ® Yea ❑ No Use this forth to report individual contributions over $50 or contributions under$50 iffbrmCRO 1205 is not used 1. Committee NLII Name sad fted if a icabie 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 7itle/Profession d. Comments CHAIR LISA WALKER 5008 LAUREL GROVE LAANE MATTHEWS, NC 28104 (704) 458-6380 c. Employer's Name/Specific Field UNION COUNTY DEMOCRATIC PARTY e. Election Sum to Date $ 150.00 f. Prior g. Account Code It. Form of Payment I. In -Kir d Description 1. Date (mm/dd/yyyy) k. Amount ❑ 228 Credit Card 09/01/2021 $ 100.00 ❑ 228 Credit Card 09/16/2021 $ 50.00 4. Total only this Page $ 150.00 5. Total of ALL CRO -1210 Pages (This line mutt he online 6 of Detailed Summary Page CRO -1100) $ 1,731.12 ( HO -1210 NC Slatc Hoard o l Glen ions Apri12007 Amendment Contributions from Political Party Committees Pg I nt ! ® N'es ❑ No Use this form to report contrbutions from a political party 1. Committee FWI Now and Fund ifa icable 2. m Number COMMITTEE PO RE-ELECT PA I RICIA HELMS KINDLE.Y 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing .Address & Phone (include city, state, & zip) h. Comments UNION COUNTY SENIOR DEMOCRATS (UNION SD) PO BOX 665 WAXHAW,NC 28173 (704) 6184116 c. Election Sum to Date $ 50.00 d. Account Code e. Form of Payment L In -Kind Description g. Date (mm/dd/yyyy) It. Amount 226 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 Delalled Summary Page CRO -1100) $ 50.00 CRO -1220 Nc St ate Board o t Flections April2007 :Fm endmtot Reflmds/Reimbursements To the Committee Pg I of i 01's p No Use this form to report refunds received by the committee or reimbursements fora previous eVenditure. 1. Committee Flull Name and Fand if a ieable COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 2. ID Number 3. Contributor Information ❑ Add ❑ Remove " a. Full Name. !Flailing Address & Pbone (include city, state, & zip) d. Type of Committee g. Comments Candidate EF I'AC ❑ Referendum ❑ Party UWHARRIE BANK 416 W MAIN ST LOCUST, NC 28097 (704) 888-8897 e. Level Registered (Specify) h. Original Expenditure Date E3Federal 0 County: ❑ Sate ❑ Municipality: 08/31/2021 L Original Fzpeodilure Amt $ 12.00 b. Job 71tle/Professioo le. Employees Name/Specific Field f. Purpose 1j. Election Sum to Date AMY BARBEE SAID WE WERE ACCIDENTALY CHARGED A $ 0.00 k. Account Code 11. Form of Paym m. -Kind Description In. Date (mm/dd/yyyy) In. Amount 228 Draft 09/03/2021 g 12.00 4. Total only this Page $ 12.00 5. Total of ALL CRO -1240 Pages (This Rne mast be online 10 ojDetaifed Summary Page CRO -1100) $ 12.00 CRO -1240 NC Sate Boardof Elections December 2007 Amendment Disbursements Pg 1 of 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 Full Name and Fund ifapplicable) 2.IDNumber COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Type of Djs borsement (Please use separate CRQ1310 forms for each lupe ofUisbursernent.) Operating Expenses U Contributinns'to CandicLdcs/Pnlitical Committees 0 Coordinated Partv Expenditures 4. Payee Eaformation ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zi b. Coordinated Committee Name d. Comments SUPER CHEAP SIGNS 9200 WATERFORD CENTRE BLVD #100 AUSTIN, TX 78758 (866) 270-7446 c. Level Registered (Specify) Federal 0 County: ❑ State ❑ Municipality: e. Election Sum to Date $ 1,084.00 E Account Code g. Form of Payment 1h. Purpose Code ji. Date (mm/ddlyyyy) j. Amount 1k. Required Remarks 228 Debit Card O 09/21/2021 1 $ 1,084.00 1 YARD SIGNS Is 1 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state,& zi It. Coordinated Committee Name d. Comments VISTA PRINT NETHERLANDS BV COMPANY HUDSONWEG 85938 -LW VENLO UTLANDET, NORWAY, NC 85938 (866) 207-4955 e. Level Registered (Specify) 0Federal L3 County: ❑ State ❑ Municipality: e. Election Sum to Date $ 63.88 L Account Code g. Form of Payment h. Purpose Code E. pate (esmiddlyyyy) I. Amount 1k. Required Remarks 228 Debit Card B 09/05/2021 $ 63.88 18 X 24 POSTERS $ 5. Total only this Page $ 1,147.88 6. Total of ALL CRO -1310 Pages (This line goes in Une 13a of Detailed Summary Page CRO -1100 0,0perabng Expenses) (This line goes in line 13b ofDetalled Summary Page CRO-11001fContrib to CandidateslPoOdeal Comm) (This line goes in line 13c of Defalled Summary Page CRO -11001f Coordinated Parry Expenditures) $ 1,147.88 7. PurpOSe Codes (List detailed expenditure code in (h.) above) A* - Media B* - Printing C* - Fundraising D -To Another Candidate E - Salaries P - Equipment G - Political Party H* - Holding Public Office Expenses 1 - Postaee 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 Stale Board of Elections December 2009 Amendment Aggregated Non -Media Expenditures Page l or 2 ® Yes ❑ No Optional form used to report NC Non -Media Expenditures of $50 or less. CRO -1315 NC State Board of Elections December 2009 COMMITIEL TOR I; -ELECT PA IRIC [A HELMS KINDLEY 3. Payee Information a. Amend b. Account Code c. Form of Payment d. Purpose Code e. Date (mm/ddlyyyy) f. Amount g. Required Remarks Add 228 Draft o 09/01/2021 $ 0.38 APPLICATION FEE ❑ Remove Add 228 Draft O 09/01/2021 $ 0.75 APPLICATION FEE ❑ Remove Add 228 Draft O 09/01/2021 $ 0.75 FIENDS TRANSFER ❑ RemoveFE Add 228 Draft O 09/01/2021 $ 0.75 APPLICATION FEE ❑ Remove =Add 228 Draft O 09/01/2021 $ 0.75 APPLICATION FEE ❑ Remove =Add 228 Draft O 09/01/2021 $ 1.50 APPLICATION FEE ❑ Remove =Add 228 Draft O 09/02/2021 $ 0.75 APPLICATION FEE ❑ Remove Add 228 Draft O 09/07/2021 $ 0.60 APPLICATION FEE ❑ Remove =Add 228 Draft O 09/09/2021 $ 0.75 APPLICATION FEE ❑ Remove Add 228 Draft O 09/15/2021 $ 1.50 APPLICATION FEE ❑ Remove Add 228 Draft O 09/15/2021 $ 1.50 APPLICATION FEE ❑ Remove =Add 228 Draft O 09/16/2021 $ 0.38 APPLICATION FEE ❑ Remove Add 228 Draft O 09/16/2021 $ 0.75 APPLICATON FEE ❑ Remove =Add 228 Draft O 09/16/2021 $ 0.75 APPLICATION FEE ❑ Remove Add 228 Draft O 09/20/2021 $ 0.30 APPLICATION FEE ❑ Remove Add 228 Draft O 09/21/2021 $ 1.50 APPLICATION FEE ❑ Remove Add 228 Draft O 09/01/2021 $ 1.03 PROCESSING FEE ❑ Remove Add 228 Draft O 09/01/2021$ 1 75 PROCESSING FEE ❑ Remove Add 238 Draft O 09/01/2021 $ 1.75 PROCESSING FEE ❑ Remove Add 128 Draft O 09/01/2021 $ 1.75 PROCESSING FEE ❑ Rcnnn c 4. Total only this Page $ 19.94 5. Total of ALL CRO -1315 Pages $ 156.28 (This line must be online 14 of Detailed Summary Page CRO -1100) 6. EMUM, Codes List detailed expenditm code in d above B* - Printing C* - Fundraising D -To Another Candidate L - Salariesmeat G - Political Par" H* —Holding Public Office Expenses°- 1 - P e, J - Penalties K* - Office Expenses Q* - Donations to Legal Expense Fund O* - Other * Codes require detailed explanation in required remarks field CRO -1315 NC State Board of Elections December 2009 Amendment Aggregated Non -Media Expenditures Page 2 of 2 El Yes ❑ No Optional form used to report NC Non -Media Expenditures of $50 or less. CRO -1315 NC State Bond of Elections December 2009 • COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Payee Information a. Amend b. Account Code I e. Formof Payment d. Purpose Code le. Date (mm/dd/yyyy) If. Amount Ig. Required Remarks Add 228 Draft O 09/01/2021 $ 175 FUNDS TRANSFER 13 Remo" Add 228 Draft O 09/01/2021 $ 3.20 PROCESSING FEE ❑ Remove Add 228 Draft O 09/02/2021 $ 0.88 PROCESSING FEE ❑ Remove =Add 228 Draft O 09/022021 $ 1.75 PROCESSING FEE ❑ Remove =Add 228 Draft O 09/072021$ Ogg PROCESSING FEE [3 Remove . Add 228 Draft O 09/092021 $ 1.75 PROCESSING FEE ❑ Remove =Add 228 Draft O 09/152021 $ 3.20 PROCESSING FEE ❑ Remove =Add 228 Draft O 09/15/2021$ 320 PROCESSING FEE ❑ Remove . Add 228 Draft O 09/162021 $ 1.03 PROCESSING FEE ❑ Remove Add 228 Draft O 09/162021 $ 1.75 PROCESSING FEE ❑ Remove Add 228 Draft O 09/162021$ 175 PROCESSING FEE 13 Remove Add 228 Draft O 09212021 $ 3.20 PROCESSING FEE ❑ Remove Add 228 1 Check C 08/242021 $ 50.00 PARK SHELTER 1:3 Remove FOR EVENT Add 228 CheckC 09212021 $ 50.00 FUND RAISING ❑ Remove Add 228 Draft O 08/31/2021 $ 12.00 BANK CHECKING IFEE [3 Remo" 4. Total only this Page $ 136.34 5. Total of ALL CRO -1315 Pages $ 156.28 (This line must be online 14 of Detailed Summary Page CRO -1100) 6. Purpose Codes List detailed expenditure code in d above B* - Printing C* - Fundraising 411ILD - To Another Candidate F; - Salaries F* -1pt G - Political Party g I - Postage I - Penalties K* -Office Expenses IQ* -Donations to Legal Expense Fund O* -Other * Codes re vire detailed explanation in required remarks field CRO -1315 NC State Bond of Elections December 2009 Amendment In -Kind Contributions Pg of A Yes ❑ No Use this forth to report non -monetary contributions, donations, goods or services provided to he committee or fund. Use CRO -1215 if In -Kind Contributions were or will be refunded within 7 days. 1. Committee Full Name(and FLndifapplicable) Z. r COMMITTEE TO RE-ELECT PATRICIA HELMS KINDLEY 3. Contributor Information ❑ Add ❑ Remove a. Full Name, ]jailing Address & Phone (include city, state, & zip) b. Type of( ontributor C. Comments Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source KRISTA KINDLEY MARTIN 4973 FOLLANSBEE ROAD WINSTON SALEM, NC 27127 (336) 793-79$7 d. Election Sum to Date $ 126.12 e. Description L Date (amlddlyyyy) g. Fair Nlarkel 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 (This ane masr be on line 17 ojDefaffed Summary Page CRO -1100) $ 126.12 CRO -1510 NC State Board of Elections December 2007