Lein,Jamie_2019-Year-endAmendment
Disclosure Report Cover 1 ❑ vee ® No
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
a. Full Name
c. m Number
Jamie Lein Campaign
JYMOZ9
b. McNag Address (include City, State and Zip Code)
d. Date Filed
1025 Seminole Drive
01/30/2019
Marvin, NC 28173
e. Phone Number
(704)619-7461
2. Report Year
3. Period Start Date (mm/dd/y))
4• Period End Date
5. Treasurer Full Name
(mm/dd
2019 07/1-5,2019
12/31/2019
Audrey Lavelle
6. Type of Committee Check One
9. Type
of Report check o
one tjwe of rMepon
one cat
® Candidate Campaign ❑ Party
Municipal
State/County
Rerereadoes
❑ PAC ❑ Referendum
❑
Organizational
❑ Organizational
❑ Organivational
Independent ❑ Joint Fundraiser
Expenditure ❑
❑
Thirty-five de
my- Y
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑
❑
Pre-primary
pre-election
❑ First
❑ Second
❑ Final
❑ Supplemental Final
7. T of Fund (ifo phcable, check ow)
❑ 'Booster Fund"
❑ Building Fond
❑
Pre runoff
❑ Third
❑ Annual
Semi-annual
❑ Fourth
❑ Special
❑
Mid Year
Semi-annual
❑ Other
®
Year End
❑ Mid Year
1-
❑
Final
❑ Year End
NT`(
8. Number of Fundraisers this Report
❑
special
❑ Final
C) a O
El special
_-
11. Account Information
11. Account Information
a. Financial Institution Full Name
s. Financial Institution Full Name
First Citizens Bank
It. Purpose
c. Account Code
b. Purpose
c Accoamt Code---
Campaign
1
d. Period Begin Balance
d. Period Begin Balance
Account for
Receipts and
$ 0.00
$
Expenditures
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 finds 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 tJC St to Board of EI ions.
5-
Audrey Lavelle
01/30/2020
Printed Name of Signer
Signatu fAppointed Treasurer
Date
FOR OFFICE USE ONLY
/
Date Received: /
Employee:
Delivery Method
Normal Mail
Date Postmarked: D
Employee:
Registered Mail
9
1
Hand Delivered
Date Scanned:
Employee:
❑ Electronically Filed
❑ Signer has not received
Date Data Entered:
Employee:
mandatory training
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 Oreanization (CRO -2100A -Hl to make Pnmmitt� Ph....
Amendment
Detailed Summary ❑ 1 e ® No
Use this form to summarize all disclosure reoortine forms and to total monetary information
1. Committee Full Name and Fund if applicable)
2. Typof
Re rt
3. ID Number
Jamie Lein Campaign
2019 Year End
Semi Annual Revort
JYMOZ9
Start of Election Cycle: January 1, 2019
Total this
Reporting Period
Total this
Election Cycle
4)
Cash on Hand at Start
$
0.00
$
0.00
5)
6)
7)
8)
9)
10)
11)
Aggregated Contributions from Individuals
Contributions from Individuals
Contributions from Political Party Committees
Contributions from Other Political Committees
Loan Proceeds -
Refunds/Reimbursements To the Committee
Other Receipt Sources
Ila) Interest on Bank Accounts
llb) Contributions from Not -for -Profit Organizations
Ile) Outside Sources of Income
I ld) Legal Expense Fund —Other Sources
Ile) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRo-1265)
$
$
$ 1,100.00 $
1,100.00
S $
S $
$ 138.88 $
138.88
$ $
$ $
$ $
$ $
$ $
$ $
12)
13)
14)
15)
16)
17)
TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10, Ila Jib, 11c, Ildand Ile)
Disbursements
13a) Operating Expenditures (CRO -1310)
13b) Contributions to Candidates/PoliticalCommittees (CRO -1310)
13c) Coordinated Party Expenditures (CRO -1310)
Aggregated Non -Media Expenditures (CRO -1315)
Loan Repayments (CRO -1420)
Refunds/Reimbursements From the Committee (CRO -1320)
In -Kind Contributions (CRO -1510)
$
1,238.88
$
1,238.88
S 1,155.88
$
1,155.88
$ $
S $
S S
$ $
S $
$ $
18)
TOTAL EXPENDITURES (Add lines 13a,13b,13c,14,15,16 and 17)
S
S
19)
20)
21)
22)
23)
24)
25)
26)
277
28)
Cash on Hand at End (add lutes 4 and 12 together, (hen subtract line 18)
D
Non -Monetary Gifts Given to Other Committees (CRO -1330)
Outstanding Loans (incl. ones from other campaigns) (CRO -1430)
Debts and Obligations owed By the Committee (CRO -1610)
Debts and Obligations owed To the Committee (CRO -1620)
Account Transfers Within the Committee (CRO -1720)
Administrative Support (CRO.1710)
Forgiven Loans (CRO.1440)
48 -Hour Notice Reports Sum (CR0.2220)
Contributions to be Refunded (CRO -1215)
$
83.00
$
83.00
$ 202.26
$
$
S
$
$ $
S Q`J
$ $
$ $
S $
CRU -1160 NC State Board of Elections Amon 2008
Amendment
Contributions from Individuals Pg I of 1 ❑ Yes ® No
Ilse this form to report individual contributions over $50 or contributions under $50 if forth CRO 1205 is not used
1. Committee Full Name and Fund if applicable)
Jamie Lein Campaign
2. ID Number
JYMOZ9
3. Contributor Information ® Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & tip)
It. Job Title/Profession
d. Comments
Jamie Lein
1025 Seminole Drive
Marvin, NC 28173
(704) 619-7461
c. Employer's Name/Specific Field
a Election Sam to Date
$ 1,100.00
E Prior
g. Account Code
b. Form of Payment
i. la -Iliad Description
J. Date (mmlddlyyyy)
It. Amount
❑
I
Transfer
07/25/2019
$ 1,000.00
❑
1
Transfer
12/10/2019
$ 100.00
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & tip)
b. Job'I itle/Profession
d. Comments
e, Employer's Name/Specific Field
e. Election Som to Date
$
E Prior
g. Account Code
Is. Form of Payment
i.In-Kind Description
j. Date (mm/dd/yyyy) it. Amount
❑
$
❑
$ uNT
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & tip)
b. Job Title/Profeadoo
d. Comments
7
G�
ESE
c. Employer's Name/Specific Field
e. Election Som to Date
$
E Prior
I g. Account Code
It. Form of Payment
E In -Kind Description
J. Date (mmlddlyyyy)
b, Amount
❑
$
❑
$
❑
$
4. Total only this Page $ 1,100.00
5. Total of ALL CRO -1210 Pages $ 1,100.00
(This One ncust be on line 6 of Detailed Sanctuary Page CRO -11 rid)
CRO -1210 NC Slate Board of Elections April 2007
Amendment
Loan Proceeds Pg 1 of I ❑ Yes ® No
Use this form to report proceeds from a loan and loan endorser's information
A loan proceeds statement must accompany each loan that is from an individual
1. Committee Full Name and Fund if applicable)
2. IID Number
Jamie Lein Campaign
JYMOZ9
3. Lender Information
® Add ❑
Remove
a. Full Name, Mailing Address & Phone
(include city, state, & rip)
b. Job Title/Profession
d. Comments
Bank Overdraft
Protection
SunTrust Bank
e. Start Date (mm/dd/yyyy)
a Employer's Name/Specific Field
11/27/2019
E End Date (mm/dd/yyyy)
g. Rate h. Security Pledged
L Account Code
J. Form of Payment
h. Amount
%
I
Transfer
$ 138.88
L Full Name of Leading Institution
m. Loan Number
4. Endorsers/Makers (The people who guarantee the loon.)
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
c. Employer's Name/Specific Field
d. Percentage
e. Amount
$
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job TRIe/Profemion
c. Employer's Name/Specific Fie
Op
O �� O
Z 0 (D
d. Percentage
e. Amount Q
%
$ E��G
a. Fall Name, Mailing Address & Phone
(include city, state, & zip)
It. Job Thle/Profemion
c. Employer's Name/SWelfic Field
d. Percentage
a Amount
%
$
a. Fall Name, Mailing Address & Phone
(include city, state, & zip)
It. Job Title/Profession
c. Employer's Name/Specific Field
d. Percentage
e. Amount
%
$
5. Total of ALL CRO -1410 Pages
(This line must he on Line 9 ojDetaded Summary Page CRO -1100)
$ 138.88
Disbursements El ve
Pg s
g i or 3 ❑es ® No
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 and Fund iiiapplicable) 2. ID Number
Jamie Lein Campaign 1 JYMOZ9
3. Type of Disbursement Please use separate CRO -1310 form for each type of Disbursement
MOperating Expenses ❑ Contributions to ('andtdates'Pobttcal Committee, ❑ Coordinated Parte Expenditures
4. Payee Information Add 0 Remove
a. Full Name, Mailing Address & Phone
include city, state, & ri
b. Coordinated Committee Name
d. Comments
Build A Sign.eom
a Level Registered (Specify)
❑ Federal ❑ County:
❑ State M Municipality:
t. Election Som to Date
$ 499.59
E Account Code
I g. Form of Payment
h. Purpose Code
L Date (mm/ddlyyyy)
J. Amount
W Required Remarks
1
Check Card
B
08/14/12019
$499,59
Campaign Yard
Signs
$
�VNTV
4. Payee Information Add Remove e
a. Full Name, Mailing Address & Phone
include city, state, & zip)
b. Coordinated Committee Name
d. Comments ti F
OP'O �O
0E`�GC
Sam's Club #6348
11425 Carolina Place Parkway
Pineville, NC 28134
(704)541-1234
a Level Registered (Specify)
❑ Federal ❑ County:
❑ state M Municipality:
a Election Sam to Date
$ 98.74
E Account Code
g. Form of Payment
h, Purpose Code
L Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
1
Debit
O
10/17/2019
$98.74
Cookie Tray for
Meet and Greet
4. Payee Io16restation dd `"' Remove
a. Full Name, Mailing Address & Phone
(include city, state & a
b. Coordinated Committee Name
d. Comments
AlphaGraphics
10100 Patio Cedar Drive
Suite 178
Charlotte, NC 28210
704 541-3678
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ state M Municipality:
e. Election Sum to Date
$ 508.05
E Account Code
g. Form of Payment
h. Purpose Code
L Date (mm/dd/yyyy)
J. Amann
k. Required Remarks
1
Check Card
B
11/27/2019
$301.73
Yard Signs for
Meet & Greet
1 Check Card B 11/27/2019 $206,32
6. Tots) of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed Summan, Page CRO -1100 if Operating Expenses)
(This line goes in fine lab of Detailed Su nnay Page CRO -1100 ifC'ontrib to Candidares/Politiral Comm)
(This line goes in line He of Derailed Summan� Page CRO -1100 if Coordinated Parer Expenditures) 7
Banners for
Meet and Greet
$ 1,106.38
$
7. Purpose Codes(List detailed expenditure code inabove
A* - Media B* - Printing C* - Fundraising D - J o 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 cxulanation in required remarks field W
Amendment
Disbursements Pg 2 of 3 ❑ Yea ® 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
Jamie Lein Campaign i JYMOZ9
3. Type of Disbursement lease use separate CRO -1310 ferns for each &Pe of Disbursement.
® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures
4. Payee Information Add Remove
a. Full Name, Mailing Address & Phone
include city, ante, & A
b. Coordinated Committee Name
d. Comments
SunTrust Bank
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
a Election Sum to Date
$
L Account Code
g. Form of Payment
h. Purpose Code
L Date (mm/dd/yyyy)
J. Amount
k. Required Remarks
1
Draft
O
09/18/2019
$3.00
Paper Bank
Statement Fee
I
Draft
O
10/18/2019
$7.00
Bank
Maintenance Fee
4. Payee Information ❑ Add Lj Remove O
a. Full Name, Mailing Address & Phone
include city, state, & zip)
b. Coordinated Committee Name
d. Comments el
7 c(ft0OPPO
a Election Som to Date
SunTrust Bank
e. Level Registered (Specify)
Federal ❑ County:
❑ State ® Municipality:
$
E Account Code
g. Form of Payment
h. Purpose Cade
L Date (mm/ddlyyyy)
j. Amount
k. Required Remarks
I
Draft
O
10/18/2019
$3.00
Paper Bank
Statement Fee
1
Draft
O
11/18/2019
$7.00
Bank
Maintenance Fee
4. Payee Information
Remove
a. Full Name, Mailing Address & Phone
include city. state & zip)
It. Coordinated Committee Name
d. Comments
SunTrust Bank
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ state ® Municipality:
e. Election Sum to Date
$
E Account Code
g. Form of Payment
Is. Purpose Code
L Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
I
Draft
O
11/27/2019
512.50
Overdraft
Protection Fee
1
Draft
O
12/17/2019
$7.00
Bank
Maintenance Fee
$ 39.50
$
5. Total only this Pae
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses)
(This line goes in line 136 of Detailed Summar' Page CRO. 1100 if Contrib to CandidatevPolitieal Comm)
(This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expendimres)
7. Purpose Codes(List detailed expenditure code in above
A* - Media B* - Printing C* - Fundraising D -'I o 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 exDlanation in reauired remarks field tkl
2
�O
Amendment
Disbursements
Pg 3 of 3 ❑ Yes ® Na
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 a Neable 2. H) Number
Jamie Lein Campaign JYMOZ9
3. Type of Disbursement Please use separate CRO -1310 fornits for each type of Disbursement
® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures
4. P93" Information Add El Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
In. Coordinated Committee Name
d. Comments
SunTrust Bank
a Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sam to Date
$ 49.50
f. Accouat Code
g. Form of Payment
h. Purpose Code
L Date (mm/dd/yyyy)
j. Amount
h, Required Remarks
I
Draft
O
12/17/2019
$3.00
Paper Bank
Statement Fee
1
Draft
O
12/17/2019
$7.00
Bank
Maintenance Fee
4. Payee Information Lj Add Remove
a. Full Name, Mailing Address & Phone
include city, state, & zip)
Is. Coordinated Committee Name
d. Comments
NTY
a
e Q��L]Federal
rod Oe�
6':'Zooe
c. Level Registered (Specify)
ElCounty:
❑ state ❑ Municipality:
e, Election Som t
bite .�,
$ 00 ` G�
E
f. Account Code
g. Form of Payment
Is. Purpose Code
L Date (mm/ddlyyyy)
J. Amount
L Required Remarks
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state & zip)
b. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality:
e. Election Sum to Date
$
L Account Code
g. Form of Payment
h. Purpose Code
L Date (mm/ddlyyyy) j. Amount
h. Required Remarks
5. Total only this Page $ 10.00
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Fxpenses)
(This line goes in line 13b of Delailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm) $ 1,155.88
(This line goes in line He of Delailed Summan• Page CRO -1100 if Coordinated Parry Expenditures)
7. Purpose Codes(List detailed expenditure code in 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 reauired remarks field (k)
Non -Moneta Gifts Given to Other Committees Amendment
f')r Fa 1 of 1 ❑ Yes ® No
Use this form to report any in-kind, non -monetary gift, service or items given to another committee.
1. Committee Foil Name and Fund if applicable)
2. ID Number
Jamie Lein Campaign
JYMOZ9
3. Payee Information ® Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & tip)
b. Type of Committee
d. Comments
® Candidate ❑ PAC
❑ Referendum ❑ Party
Expenses owed
to Jamie Lein
Campaign not
paid back by
Christopher
Smith Campaign
Christopher Smith
212 Cattle Ridge Ihivee
Marvin, NC 28173
(402) 707-5201
e. Level Registered (Specify)
❑ Federal ❑ County:
❑ state ® Municipality:
e. Type of Gift
❑ Coordinated Party Expenditure ® Contribution to Candidate/Political Committee
L Description
g. Date (mm/dd/yyyy)
Is. Fair Market Amount
1/3 Cost of Cookie Tray for
Meet and Greet
10/17/2019
$ 32.91
1/3 Cost of Banners and Yard Signs for
Meet and Greet
11/27/2019
$ 169.35
3. Payee Informatio" " Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Type of Committee
it. Comments —
❑ Candidate ❑ PAC
❑ Referendum ❑ Party
GC
,\,ea Q�Q
C P�GQ' rQ"'
O
Qt
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ state ❑ Municipality:
e. Type of Gift
❑ Coordinated Party Expenditure ❑ Contribution to Candidate/Political Committee
L Description
g. Date (mm/dd/yyyy)
h. Fair Market Amount
$
$
3. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Type of Committee
it. Comments
❑ Candidate ❑ PAC
❑ Referendum ❑ Party
L Level Registered (Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality:
e. Type of Gift
❑ • Coordinated Party Expenditure ❑ Contribution to Candidate/Political Committee
E Description
g. Date (mm/dd/yyyy)
Is. Fair Market Amount
$
4. Total only this Page $ 202.26
5. Total of ALL CRO -1330 Pages
$ 202.26
(This line must he on line 20 of Detailed Summon• Page CRO -1100)
CRO -1330 NC State Board offlections December 2007
)A?