King,Michele_2021-Year-endAmendment
Disclosure Report Cover ❑ Yes ca_�Ke
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 u date information.
Come Intormatie�
Full Name
c. ID Number
a. —f -b e cd Ck � C lU
e 3 -2
. Molft Address (Wade city, Stole and Zip Code) U
Date FBed
3 0 a 1;. �f"_4 -t
01-.)'7-ao
e. Phone Number
rl 0 1 '191• la3US
Report Year
3. Period Steri )lam 4. Period End Date
5. Traeurer FnII _
ao'ai
/0-]q -coal fa -31 - aoal
I rnC'ut4_lti �. 1:�c
6. Tyw of CormdUee Check One
of rt (check only one type of re rt one cate o )
Candidate Campaign ❑ Patty
Munulod
State/County
Referendum
❑ PAC ❑ Referendum
❑ Organizational
❑ Organizational
❑ Organizational
❑ Independent Expenditure ❑ Joint Fundraiser
[3 Thirty-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑ Pro -primary
❑ Fust
❑ Final
❑ Pre-election
❑ Pre-ranoff
Semi -arcual
❑ Second
❑ Third
❑ Fourth
❑ Supplemental Final
❑ Annual
❑ Special
7. Of FaW (ifapplicabk, check are)
❑ Booster Fund
❑ Building Fund
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
10. spaw x4god NOW
❑ other:
❑ Final
❑ Special
❑ Year End
❑ Final
❑ Special
IL Number of Faadrailoers this Report
1. Account Infornradm
11. Accoont Information
o. Financial I Full Name
a. Fiaencial IaatltLaon Full Name
-Ob-4 7 rl o (J Drt SJ--
Putpow
e, Account Code
b. Papose
e. Account Code
carnpal�n accou�f
bl
Xay far CL 1 p 4-,6
a. Pww Begin Belaooe
d. Period Begin Balance
$ 0 511.55
$
V(
CEW17f CATION
I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 2213-22M 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.
rYIiC'(tilti ` 01 —a$ ao�
Printed Name of Si er. Si taro of AppinfitekTreas#xer Date
OR OFFICE USE ONLY
Date Received: Em
' [3 Normal Mail
Date Postmarked: Employee: Registered Mail
Hand Delivered
Date Scanned: D 1 2a- Employee: ❑ Electronically Filed
Date Data Entered: Em to ee: ❑Signer has not received
P y mandatory trainin
Please Note: This form cannot be used to amend committee information such as the committ(xt�ddress treasuteq
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
_
RECEIVED
•Detailed S eot
Summary 0 Yea
Use this form to summarize all disclosure re.norrino forms and to total mnnetary infnrmatinn
1. Committee Fulf Name (and Fund if applicable)
o 4b ij d44 A 1'
2. Type of Report
tar ltd
3. ID Number
(2- J 4 � C
Start of Election Cycle: January 1, Q-oa-o U
Total this
Reporting Period
Total this
Election Cycle
4) Cash on Hand at Start
$ '4 6 Z 1. 5.5
$ q S 71• 65
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
0) Refunds/Reimbursements to the Committee
1) Other Receipt Sources
11a) Interest on Bank Accounts
Ilb) Contributions from Not-For-ProQt Organizations
Ile) Outside Sources of Income
1ld) Legal Expense Fund - Other Sources
Ile) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
ww-wo)
(CRO.1250)
(CRO -1270)
(CRO -1265)
$
$ 50-00
$ 100-00
$ S (o0 •*TS
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9,10,l la,11b,l lc,1(d and Ile!
$ 100. 0 O
$ 5, D.-75
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO -1310)
13b) Contributions to Candidates/Political Committees (CRO -1310)
13c) Coordbuded Party Expenditures (tom -1310)
4) Aggregated Non -Media Expenditures (CRO -1315)
Loan Repayments (CRO -1420)
$ e1
$
$
$
$
$
$
$
$
$
6) Refunds/Reimbursements from the Committee
7) In -Bind Contributions
(CRO -1320)
(CRO -1510)
$
$
$
$
8) TOTAL EXPENDITURES (Add linea 134 13b, 13c, 14, 15, 16 and 17)
$ l i y 1 41.5 3
$ e5 3 (0 Is
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$
$ f./.
IONAL INFORMATI N
-Monetary Gifts Given to Other Committees
standing Loans (incl. ones from other campaigns)
ts and Obligations owed by the Committee
ts and Obligations owed to the Committee
Account Transfers Within the Committee
inistrative Support
iven Loans
[7)48-HourNotice Reports Sam
(CRO -1330)
(CRO -1430)
(CRO -1610)
(CRO -1620)
(CRO 1n0)
(CRO -1710)
(CRO -1440)
(CRO -2220)
$
$
$
$
$
$
$
$
$
$
$
tributions to be Refunded
(CRO -121S)
r $
$
CRO -1100 NC State Board of Elections August 2008
Debts and Obligations Owed By the Committee Pg of Amendment ❑ Yes p'& -
Use this to to re ort any on aid debts or obli ations owed by the committee, to include campaign credit card purchases.
1. o ttee a>rre a caunaw
Creditor Information LJ Add LJI Remove
. Full Name, Mailing Address & Phone
(include city, state, & zip)
Note: All payments made toward debts should be listed on form CRO -
1310 with the payee listed as this creditor.
.0 ox *00��)F
it f4c, 29-9
b. Description of Creditor
�044CltO.L- N�/12'C I�TKt int
CM 41+
. Beginning Balance
Id. ToW Amount Paid
e. Total Amount Incurred f. Rem Balance
$
1 $ q�,ej. 33
$ l$'t'1z $
. Incurred Debts (what the committee received this period)
1. Purchase Place Full Name, Mailing Address & Phone
(include city, state, & zip)
III Date (mm1&lVyyyy)
jg3. Amount
0110), a oat
$ a?. o 0
e- 6 W �vG
P-6-
Lj i Bart Ax, VT 4 4 10 0
g0.>�Pcee Code
gs. Requlred Remerb
U
-(I
1. Purchase Place Full Nam, Mailing Address & Phone
(include city, stab, & ZIP)
g2. Date (mm1WJyyyy) g3. Amount
10
3S p g Is4,5,-79
9 r� KO W �` Yk —
�P.b . 130(< 4f60
(,J il'aWl NG 1�1?8O4 DU
ga Purpox Cadee ISS
Required ReRemarb
U
c4
C
t. Purchase Place Fall Nam, Mailing Addrem & Phone
(include city, state, & alp)
92. Date (mtm/ddlyyyy)
g3. Amount
till
-(J-2-02 1
$ 1 47 . 0 C>
Wy- • e z r%.... 1 LT D
HO n a r•r,a l D4 P O✓ (f 3500-1/�
g4 purpose code
IgS. Iteclulred Remarb
s�
(v & ra.lhi 1('
1. Purchase Place Full Name, Mailing Address & Phone
(include city, stat, & zip)
g2. Date (n Wdd/yyyy) I&% Amount
l 1
n n
2(D 3oa-I L-1
-t� • �
rJ `) T
�. 0 3 t x ,-( oo
ti l -;-n XfC `q Q(F - 04 DO
g4. Purpose Code
IgS. fired Remarks
ce-
I. Purchase Place Full Name, Mailing Address & Phone
(include dry, state, & zip)
g2. Date (mmldd/yyyy)
IgI,moont
$ l9 •Oo
wil C txv% t LTO
Ho namat ,qtl K{viV WNP71
g4. Purpose Com
IgS- R"WrW Remarks
rnlcl !
7�r i wt (ate .-.
4. Total $
(This should be the sum of all items 'g3.' from this age) l L2 a • 0
5. Total of ALL CRO -1610 Pages $ B
(This line must be on line 22 of Detailed Summary Page CRO -1100)
"M Codes (List detailed expenditure
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 O* - Other
* Codes require detailed explanation in required remarks field (g5.)
CRO -1610 NC State Board of Elections Feb) ary2011
RECEIVED
Amendment
Debts and Obligations Owed By the Committee Pg '2- of a❑vee p -Aa
. Full Name, Mailing Address & Phone
(include city, state, & zip)
�v'wls=l 3an.lc—
q �OX f 0C
l k) 3qq— b4-oo
c. Beginning Balance & Tood Amount paid
. incurred Debts (what the committee received this period)
1. Purchase Place Full Now, Mailing Address & Phone
(include city, state, & zip)
-2 37- l-� w
r1. Purchase Place Full Name, Ma
(include city, state, & zip)
(include city, state, & zip)
I (include city, state, & zip)
' (include city, state, & zip)
gad LJ Remo
Note: All payments made toward debts should be listed on form CRO -
1310 with the payee listed as this creditor.
R Deeaipt on of Creditor
aioL-C+-a-e,
Total Amount Incurred if. Remaining Balance
$ 1 $
i��a�(atai $ aa.lo�
Purpose Code Igs. Re tdred ltemari®
CO&
. Purpose Code
Cade
&j
E5
1�
Required Remarks
El
. a true vwy wrn r ngc
(This should be the sum of all items 'g3.' from this age)
5. Total of ALL CRO -1610 Pages
(This line must be on line 22 of Detailed Summary Page CRO -I 100) $
(List6. Puvose Codes i
A - Media B - Printing Fundralsmg - o not er an ate
E Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses
I - Postage J - Penalties K* - Office Expenses O* - Other
* Codes require detailed explanation in required remarks field (g5.)
r _1410 Nr . tate Rnaai of Flrc nna Frhma in l l
Disbursements Pg I of I_ Amendment❑ Yes 11
Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political
committees and coordinated party expenditures
1. Committee Fall Name (awl Fund_if applicable)
" Numbw
12. ID
CoUj ifC-�
TM 24ff—
13.. 1Type of Disbursement (fkase use separate CRO -1310 forms fore twe_ ofDrsbursemex 1
L•1 Openning Ex nsesContributions to Candidates/Political Committees Coordinated Party Expenditures
4. Payee Information ❑ Add Remove
a. Full Name, Mailing Address & Phone
include city, state, & zip)
b. Coordinated Com althe Name
d. Comments
.
nn
513-71 rLC)W � M i s+
p.0 _ 13 o K 46Q
C V„ OY'T •t-
W 1 (p ,M � �'19 /I r 1 ' u LI O D
c. Level Registered (Specify)
U Federal L] County:
❑ State I m- unicipality:
e. Election Sam to Date
$
. AccountCode
g. Form d Payment
JILParPOWC06
IL Date lmmlddfyyyy)
. Amount
1k. Required Remarks
61
-
0.1 zs 2 6 t1
$i o0 00
to eAt
61
t
d
II to ZOZI
$ 330.33
C (Y(eht —
4. Information Add Remove
a. Full Name, Mailing Address & Pbone
(include city, state, & zip)
b. Coordinated Committee Name
d. Comments
y�
la `t -T no (.l! d fM I S�
O (:.� or �oO
/`
£f►n A)r, 2`J aqq- og00
e Level Registered (Specify)
Federal County:
❑ State ❑ Municipality:
e. Election Stmt to Date
$
. Account code
g. Four of payment
h. PurPm Code
1. Date (mmfddtyyyy)
J. Amount
IL Requited Remarks
C) l
tr
19414.1LOA
$ (e4• oo
e C
$
4. Payee Information Add 0 Remove
. Full Name, Mailing Address & Phone
(include city, state, & zip)-
b. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
Q Federal U County:
❑ State ❑ Municipality:
e. Election S®to Date
. Account Code
g. Form of Payment
h. Purpose Code
1. Date (mm/ddlyyyy)
J. Amount
IL Required Remarks
$
. Total only this Page
1 $ N it a 01 . 3
. Total of ALL CRO -1310 Pages
(This tine goes in Une 13a of Detailed Summary Page CRO -1100 if Operating Expenses) $
(This line goes in line lab of Derailed Summary Page CRO -1100 jf Contrib to CandidateslPoUtical Comm)
This line Roes in Use Be of Detailed Summary Page CRO -1100 if Coordinated Party F.x nditures)
7. Purpose Codes (List detailed expenditure code in (h.) above)
* - Media B* - Printing C* - Fundraising D - To Another Candidate
E - Salaries F* - Equipment G - Political Party He - Holding Public Office Expenses
Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* Other
* Codes require detailed explanation in r uired remarks field
CRO -1310 NC State Board of Elections December 2009
Contributions from IndividualsPg Of I L_
Yet
p
Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used
ommitiee - ams tam •' --. --
— COui !. (" 1uee jqr'cc(FP� I e j " (-
3. Contributor Information 0 Add Remove
. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job TitlelPrafemlon
d. Comments
Q w U 16 ,w
lel a Fu. L -'80k-
3 ob 5 Ti -ffanN 1bV`,Ve,
(Ntotmf- aG guo-bflil
C. err's NambspMec Hold
11
OJQ2ty erto-fiou
dam,
e.Election Semionate
1 $ /on
r.Prior
g. Aeommt Code
b. Foam otPsymesd
i. Ia-Biod Desaiption
J. Date (mnJddfyyyy)
L Amount
❑
of
Cke,4—
f I 2e, I u,aI
$ I0o.00
❑
$
❑
$
3. Contributor Information 0 Add 0 Remove
. Full Name, Mailing Address & Phone
(imdude dty, sVtq & zip)
b. Job Tittaftotession
d. Comm mis
-- --
c Employer's NemdSpeeilic Field
e. Flection Su7DaOte
$
. Prior
4 Account Cade
h Foem at Payment
L Its -Kind Deseelptlon
.Date (ma✓dd/yyyy)
i Amoun
❑
$
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Tille/Profesem
ion d. Coments
c. Employer's Name/Sped6c Field
e. Unction Stun to Date
$
. Prior
❑
g. Account Code
It. Form of Payment
i. In -Kind Description
J. Date (mmltldlyyyy)
k Amount
$ _-
❑
$
❑
$
4. Total only this Page
$ Dp , 00
5. Total of ALL CRO -1210 Pages
(Tbis line must be on line 6 of Detailed Summary Page CRO -1100)
$ f 0 C) , oU
CRO -1210 NC State Board of Elections April 2007