Martin,Steve_2021-Org-disclosureAmendment
Disclosure Report Cover 1 ❑ Yes ® 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
L Committee Information
a. Full Name
c. ID Number
Committee to Elect Steve Mattin
b. Mulling Address (Include Qty, State and Zip Code)
d. Data Filed
P.O. Box 1593
CAMPAIGN FINANCE
12/06/2021
Mattitews, NC 28106
DEC 0 6 2021
e. Plume Number
704-254A789
_ , T
2. Report Year
3. Peri )d Start Date (mm/dd/yy)
4. Pcrioti FnJ Datc
5. Treasurer Full Name
mm/ddhti
2021
11/26/2021
12/06/2021
Stephen D. Martin
6. Type of Committee Check One)
9. Tym
of Report (check only
one type ofreport
om one category)
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
Organizaricaud
Organvational
Organs uonal
Independent Joint Fundraiser
❑ Expenditure ❑ e
❑
Thirty-five da
nY- Y
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑
❑
Pre -pommy
Preclmtion
❑ Fust
❑ Second
❑ Final
❑ Supplemental Final
7. Type of Fund (if grplic-Ne, check one)
❑ "Booster Fund-
❑ Building Fond
❑
Pre -runoff
❑ Third
❑ Annual
Semi-annual
❑ Fourth
❑ Special
❑
Mid Year
semi-annual
❑ Other
❑
Year End
❑ Mid Year
10. Special Report Name
❑
❑
Final
special
❑ Year End
❑ Final
❑ Special
& Number of Fundraisers this Report
0
11. Account Information
11. Account Information
a. Financial Insulation Full Name
a. Financial Institation Full Name
Wells Faro Bank, NA
b. Purpose
c. Account Code
b. Purpose
c. Account Code
all campaign
A
expenses
it. Period Begin Balance
d. Period Begin Balance
$ 0.00
$
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 prohib'ted or other no isclosed funds. I further certify that this report
is complete, true and correct and that I have been trained
by the NC EI 'ons.
_Stephen D. Martin
12/06/2021
Printed Name of Signer
tgnMre of Appoints Treasurer
Date
FOR OFFICE USE ONLY
Date Received:rmal
44j2
Employee:
Method
--L—
q#121Employee:
❑ No Mail
Date Postmarked:
Registered Mail
]-land 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
Organization (CRO -2100A -E) to make committee changes.
CR
'911000 NC State Board of Elections August 2008
Amendment
Detailed Summary ❑ Yes ® No
Use this form to summarize all disclosure reDortina forms and to total monetary information.
1. Committee Full Name and Fund if applicable) 777
of Report
3. ID Number
Committee to Elect Steve Martin
Organizational
Start of Election Cycle: January1, ZOI'I
Total this
Reporting Period
'total this
Election Cycle
4)
5)
6)
7)
8)
9)
10)
11)
Cash on Hand at Start
Aggregated Contributions from Individuals (CRO -1205)
Contributions from Individuals (CRO -1210)
Contributions from Political Party Committees (CRa1220)
Contributions from Other Political Committees (CRO -1230)
Loan Proceeds (CR&1410)
Refunds/Reimbursements To the Committee (CRo1240)
Other Receipt Sources
Ila) Interest on Bank Accounts (CRO -1250)
11b) Contributions from Not -for -Profit Organizations (CRO -1250)
Ile) Outside Sources of Income (CRO -1250)
lld) Legal Expense Fund—Other Sources (CRO -1270)
11 e) Exempt Purchase Price Sales (CRO -1265)
$
$
$ $
$ 1073.43 $
1073.43
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
12)
13)
14)
15)
16)
17)
TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10, Ila, 11 b, 11c, 11 d and Ile)
Disbursements
13a) Operating Expenditures (CRO -1310)
13b) Contributions to Candidates/Political Committees (CRO -7310)
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)
$
1073.43
$
1073.43
$ $
$ $
$ $
$ $
$ $
$ $
$ 973.43 $
973.43
18)
TOTAL EXPENDITURES (Addlmul3a,136,13c, 14, 15, 16and17)
$
973.43
$
973.43
19) Cash on Hand at End (Add lines 4 and 12 together, den wbirod lire 18)
ADDMQ
20) Non -Monetary Gifts Given to Other Committees (CRO -1330)
21) Outstanding Loans (incl. ones from other campaigns) (CRO -1430)
22) Debts and Obligations owed By the Committee (CRD -1670)
23) Debts and Obligations owed To the Committee (CRO -1620)
24) Account Transfers Within the CommkWN CONN 1 (CR0-1720)
,AMPAION FINANCE
25) Administrative Support (CRO -1710)
26) Forgiven Loans DEC 0 6 2021 (CRO -1440)
27) 48 -Hoar Notice Reports Sum R E C E I V E D(cRO-2220)
28) Contributions to be Refunded (CRO -1215)
$
100.00
$
100.00
$
$
$
$
$
$ $
$ $
$ $
$ S
CRO -1100 NC State Bomd of Elections August 2008
Amendment
Contributions from Individuals Pg I or ❑ Yes ® No
Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used
1. Committee Full Name and Fund if applicable)
2. ID Number
Committee to Elect Steve Martin
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & Ap)
b. Job Title/Profession
d. Comments
Attorney
Stephen D. Martin
405 Alucio Cf.
Wesley Chapel, INC 28104
c. Employer's Name/Specific Field
Cardinal Innovations Healthcar
e. Election Sum to Date
$ 1073.43
L Prior
g. Account Code
h. Form of Payment
i. In-Kiod Description
I. Date (mm/dd/yyyy)
L Amount
❑
A
opening deposit
12/02/2021
$ 100.00
❑
cell phone
11/26/2021
$ 53.36
❑
cell service
11/26/2021
$ 320.98
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & rip)
b. Job Tide/Profession
d. Comments
Attorney
(continuation)
Stephen D. Martin
405 Alucio Ct.
Wesley Chapel, NC 28104
c. Employer's Name/Specific Field
Cardinal Innovations Ilealthcar
e. Flection Sum to Date
$
E Prior
g. Account Code
h. Form of Payment
I. InAGod Description
j. Date (mm/dd/yyyy)
L Amount
❑
web domain
11/26/2021
$ 12.00
❑
PO Box
11/29/2021
$ 118.00
❑
Graphic design
12/02/2021
$ 449.00
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, stare, & rip)
b. Job Title/Profession
d. Comments
UNIONNANCE
CAMPAIGN F
DEC 0 6 2021
RECEIVED
c. Employer's Name/Specific Field
e. Election Sum to Date
$
I. Prior
g. Account Code
It. Form of Payment
I. In -Kind Description
I. Date (mm/dd/yyyy)
L Amount
❑
$
❑
$
❑
$
4. Total only this Page $ 1073.43
5. Total of ALL CRO -1210 Pages g 1073.43
(Phis fine nrst be" lune 6 of Ddailed Surmnary Page CRO -1100)
CRO -1210 NC State Board of Elections April 2007
In -Kind Contributions Ameodmeat
Pg 1. o[ 1 ❑ Yes ® No
Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund.
Use CRO -1215 if In -Kind Contributions were or will be refunded within 7 days.
1. Committee Fall Name and Fond if sp pfimble)2. ED Number
Committee to Elect Steve Martin
3. Contributor Information Add Remove
a. Fun Name, Mailing Address &Phone
(include cfty,state,&zip)
b.'1'ype of Contributor
c- Comments
❑ Individual
® Candidate
❑ Party
❑ PAC
❑ Referendum
❑ Other Receipt Source
Stephen D. Martin
405 Alucio CL
Wesley Chapel, NC 28104
d. Election Sum to Date
$ 973.34
e. Description
J. Date (mm/dd/yyyy)
g. Fair Market Amount
Target - campaign cell phone
11/26/2021
$ 53.36
AT&T - 12 month cell service for campaign phone
11/26/2021
$ 320.98
Google - campaign domain
11262021
$ 12.00
3. Contributor Information U Add Remove
a. Full Namc,Nailing Address & Phone
(include city, state, & rip)
b. Type of Contributor
c- Comments
❑ Individual
® Candidate
❑ Parry
❑ PAC
❑ Referendum
❑ Other Receipt Source
Stephen D. Martin
405 Alucio CL
Wesley Chapel, NC 28104
d. Election Sum to Date
$
e. Description
L Date (mm/dd/yyyy)
g. Fair Market Amount
USPS - PO Box for Candidate Committee - 12 months
11/29/2021
$ 118.00
DesignHill.com - graphic design for campaign logo
12/022021
$ 449.00
3. Contributor Information Add LLJJRemove
a. Fall Name, !Naffing Address & Phone
(include city, state, & zip) it'
b. Type of Contributor
a Comments
11- Individual
E] Candidate
❑ Party
❑ PAC
❑ Referendum
❑ Otter Receipt Source
JNIO FINANCE
AMPAIGN
DEC 6 2021
r
CC lv i— D
L a.••
d. Election Sum to Date
$
e. Description
L Date (mm/dd/yyyy)
g. Fair Market Amount
$
4. Total only this Pae $ 973.34
5. Total or ALL CRO -1510 Pages S 973.34
(This Ret nuW be on tint 17 of Detailed Samnmrr PW CRO -1100)
CRO -1510 NC State Board of Electiaas December 2007