King, Michele_2021-Org-DisclosureDisclosure Report Cover o Yf n`
Use this form for general report and committee information, must be signed and submitted along with other detailed forms.
Do not use this form to update information.
1. Committee Information
. Full Name
c ID Number
n�ili�te �-L
CAA 'L4
. Malting Address (include (Sty, State unci 73p Code)
it. Date filed
8o Z E fyzvl t i; n 4- Vljarto,r>{ N C Z.9112—
1- 1q, al
e. Phone Number
104-'1 q I -la3�s
2. Report Year
3. Period Start Date hand 4. Period End Date ima
5. Treasurer FuR Name
(t f T 4 rJ,'lJ
AA 1
`1 ' 7- A ( % - 14 - Z 1
6. T o�ttee (Check One)__9.
of Report (check onlyone type o rep ort from one category)
[a'Candidate Campaign ❑ Parry
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
Organizational
❑ Organizational
❑ Organizational
❑ Independent Expenditure ❑ Joint Fundraiser
❑ Thirty-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑ Pre-primary,
❑ First
❑ Final
❑ Pre-election
❑ Pr runoff
❑ Second
❑ Third
❑ Supplemental Final
❑ Annual
7. Type of Fund (if applicable, check one)
❑ Booster Fund
Semi-annual
❑ Fourth
❑ Special
❑ Building Fund
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
10. Special Report Name
❑ Other:
❑ Final
❑ Special
1
❑ Year End
❑ Final
8. Number of Fundraisers this Report
0
10 Special
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
gB� T
. Purpose
a Account Code
D /
b. Purpose UN
c. Account Code
C" o. Z s ~ -C ' ^ d s
c N
JUL 19 2921
a Period Begin Balance
period Begin Balan«
$ D
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 and correct and that I have been trained by the NC State Board of Elections.
Arlo&((, J4yvf.s I`�� al
Printed Name of Signer r store of ,m, Treasurer fate
FOR OFFICE USE ONLY /
DeliveryMethod
❑ Normal Mail
Date Received: %, g i Employee:*e��
Date Postmarked: Employee: Registered Mai)
Hand Delivered
Date Scanned: Employee: Electronically Filed
Date Data Entered: Employee: ❑ Smandatory ntmtreneived
Please Note: This form cannot be used to amend committee information such as the committee address, treasurer,
assistant treasurer, custodian of books information, or account information.
You must amend the Statement of Organization (CRO-210OA-E) to make committee changes.
CRO -1000 NC State Board of Elections August 2008
Amendment
Detailed Summary ❑ Yea V3 No
Use this form to summarize all disclosure revortina fortes and to total monetary information
1. Comndttee Full Name (and Fond a cab e)
2. of Report
. ID Number
orr,nti�et E�ttt ; Q�t �i
cta'I�
C.
Start of Election Cycle: January 1, 2 01
Total this
Reporting Period
Total this
Election Cycle
4) Cash on Hand at Start
I
$ Q
1
$
Q
RECEIPTS
5) Aggregated Contributions from Individuals
6) Contributions from Individuals
7) Contributions from Political Party Committees
8) Contributions from Other Political Committees
9) Loan Proceeds
10) Refunds/Reimbursements to the Committee
11) Other Receipt Sources
lla) Interest on Bank Accounts
11b) Contributions from Not -For -Profit Organizations
Ile) Outside Sources of Income
lld) Legal Expense Fund - Other Sources
Ile) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO.1U
(CRO -1250)
(CRO -1250)
(cR0.12R0
(CRO -1265)
$
$ jp .c) o
$
$
$
$
F&IGN FINANCE
$
VED
$
S
$
10 05. o
S
S
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines 5,6,7, 8,9, 10.1 la,l lb, I It, I Id and I I e)
$ 1005.00
$
Go' 5-.
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO -1310)
13b) Contributions to Candidates/Political Committees (CRO -1310)
13c) Coordinated Party Expenditures (CRO -1310)
14) Aggregated Non -Media Expenditures (CRO.1315)
15) Loan Repayments (CRO -1420)
16) Refunds/Reimbursements from the Committee (CRO -1320)
17) In -Kind Contributions (CRO -1510)
$
$
$ 2 4 8 S
$
$
$
$
$
$
$
$
$
$ !j , 00
$
$. 00
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, l6 and 17)
$ 2 a'SIT
$
Z `)
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$ rj •
$
�75 .
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees
1) Outstanding Loans (incl. ones from other campaigns)
2) Debts and Obligations owed by the Committee
23) Debts and Obligations owed to the Committee
24) Account Transfers Within the Committee
25) 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 -2220)
$
$
$
$
$
$ $
—
$ $
$ $
8) Contributions to be Refunded
(CRO -1215)
$
$
CRO -1100 NC State Board of Elections August zuus
Amendment
Contributions from Individuals Pg _ of _ ❑ Yes p1No
Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used
1. Committee Fall Name (and Ftmd if applicable)
2. ID Number
�DN(n�} et b P -ea M',eA-elf k(fl
CJ /A 2.4G
3. Contributor Information ❑ Add ❑ Remove
. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
U f
s
.coni ]_(i- -hAr)
1952 Ful r �'tt� Gh`4 n'�
t�
7`Dyt�Va �409I
904 41#4 3'1111.
c. Employer's Name/Specific Field
j
►JO{� twt �
e. Election sum to Date
$ 1OCO. 0a
f.Prior
❑
g. Aecomt Code
k Form of Payment
I. In -Kind Description
J. Date (mm/dd/yyyy)
�_cj -a I
k Amount
0
C,
$ 1000,00
❑
$
❑
$
3. Contributor Information Add ❑ Remove
. Full Name, Mailing Address & Phone
(include city, state, & zip)
MtCl,kI,. Kr,,,)
gO 2 G I W ^,w, `t k � -9t
AAO In►� f t4C 13"'L
-loq-Iti 1 b34�
b. Job Title/Profession
HF Cc+Sti1� ,4
d. Comments
c. Employer's Name/Specific Field
S' 2 �+ { yt,� ��
e. Election Sum to Date
$ 4005-.�:>
f. Prior
g. Account Code
h. Form oof,Payment
1. In -Kind Description
s�
J. Date (mmlddlyyyy)
k Amount
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
. Full Name, Mailing Address & Phone
(include city, state, & zip)
C MPP GN w GE
9 2821
b. Job Titie/Profession
d. Comments
c. Employer's Name/Speciftc Field
- -
e. Election Sum too Date
- -
$
. Prior
g. Account Code
h. Form of yment
I. rMDescription
J. Date (mmlddlyyyy)
k Amount
❑
�cr
$
❑
$
❑
$ 44
4. Total only this Page
$ (00$. 00
5. Total of ALL CRO -1210 Pages
(This line must be on line 6 of Detailed Summary Page CRO -1100)
$ 100 a
CRO -1210 NC State Board of Elections Apri12007
Amendment
Disbursements Pg _ of _ ❑ Yes ❑ No
Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political
committees and coordinated Dartv expenditures
1. Committee Full Name (and Fund if applicable)
2. ID Number
3. Type of Disbursement (Please use separate CRO -1310 forms for each tune of Disbursement.)
EloperatingExpenses y Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures
4. Payee Information ❑ Add 0 Remove
a. Full Name, Mailing Address & Phone
include city, state, & zip)
b. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
❑ Federal County:
E3 state [`Municipality:
e. Election Sum to Date
$-
. Account Code
g. Form of Payment
JIL Purpose Code
11. Date (mm/dd/yyyy)
U. Amount
k. Required Remarks
t
I
Is
4. Payee Information ❑ Add ❑ Remove
. Full Name, Mailing Address & Phone
(include city, slate, & zip)
b. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
❑ Federal ❑l --t �C"ounty:
El State [;[Municipality:
e. Election Sum to Date
$
. Account Code
g. Form of Payment
h. Purpose Code
L Date (uuo/dd/yyyy)
J. Amount
k Requited Remarks
$
4. Payee Information ❑ Add ❑ Remove
. Full Name, Mailing Address & Phone N
(include city, state, & zi �l GOUN _- -
GAMPAIG�rINNG R
JUL 9 221
RECEVED
b. Coordinated Committee Name
- - - - -
d. Comments
- -
c. Level Registered (Specify)
Federal EyCounty:
❑ State ❑ Municipality:
e. Election Sum to Date
-
$
. Account Code
g. Form of Payment
h. Purpose Code
L Date (�lddlyyyy)
j. Amount
k Required Remarks
Is
S. Total only this Page
$ 'Z g.
6. Total of ALL CRO -1310 Pages
(This line goes in line l3a of Detailed Summary Page CRO -1100 if Operating Expenses)
(This line goes in line 136 of Detailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm)
(This line goes in line 13c of Detailed SummaryPa a CRO -1100 i Coordinated Pa Ex enditures)
D 5
$ 2 y
'I O
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 re vire detailed explanation in re uired remarks field k
CRO -1310 NC State Board of Elections December 2009
Amendment
In -Kind Contributions Pg _L or I ❑ Yes 2j No
Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund.
G
I 1 ovnM,{ic* }0 e�.C, (- A: C'k*_(t PI-) I C3 M ZOIC I
a. Full Name, Mailing Address & Phone It. Type of Contributor c. Comments
(include city, state, & zip) Individual
•Itq� (}.Gtr �� n.( ® Candidate ,F,Y
❑ Party
�S� "02, G !-✓'6 h �' r S}- ❑ PAC
oyv,iut N L yS 1 ('1 ❑ Referendum d. Election Sam to Date
—71 1 - iO3(a t ❑Other Receipt Source $
e. Description f. Date (FnnVddlyyyy) g. Fair Market \mount
.d �.i\••t� 'f "f tl $ 5:00
$
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone b. Type of Contributor c. Comments
(include city, state, & zip) Indieuaal
13. Contributor
Candidate
Party
PAC
Referendum
Other Receipt Source
U Individual
❑ Candidate
❑ Party
❑ PAC
❑ Referendum
❑ Other Receipt Source
$
E$ $
Comments
.0
to
r Sum to Date
$
$
$
4. Total only this Page $ S,00
5. Total of ALL CRO -1510 Pages
(Thi, fine mual be on line 17 of Derailed Summary Page CRO -1100)
CRO -1.510 NC State Board of Elections December 2007