Martin,Steve_2021-Year-endAmendment
Disclosure Report Cover ❑ 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
1. Committee Information...
a. Full Name
c. ID Number
Committee to Elect Steve Martin
b. Mailing Address (include City, State and Zip Code)
d. Date Filed
P.O. Box 1593 CAMPAIGN FINANCE
Matthews, NC 28106
01/28/2022
e. Phone Number
JAN
2 8 2022
704-254-4789
2. Report Year
3. Period Start Date (mFwddiyy)
4. Pe E
mmiam
Tmasurer-Fult Name
2021
12 07 202_ 1
1'. ;1 1011
Stephen D. !Harlin
6. Type of Committee Check One)
9. Type of rt
(check only one &Ype of report ora one tate o
® Candidate Campaign ❑ Party
Municipal
Stste/County
Referendum
❑ PAC ❑ Referendum
❑ Organizational
❑ Organizational
❑ Organizational
Independent ❑ Joint Fundraiser
❑ Expenditure
❑ Thirty-five day
Quarterly
❑ Pre -referendum
❑Legal Expense Fund
❑ Pre-primary
❑ Pre-election
❑ First
❑ Second
❑ Final
❑ Supplemental Final
7. Type of Fund (ifapplicoble, check—)
❑ "Booster Fund"
❑ Building Fund
❑ Pre -runoff
❑ Third
❑ Annual
Semi-annual
❑ Fourth
❑ Special
❑ Mid Year
Semi-annual
❑ Other
❑ Year End
❑ Mid Year
10. Special Report time
❑ Final
❑ Special
® Year End
❑ Final
❑ Special
8. Number of Fundraisers this Report
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
Wells Faro Bank, NA
b. Purpose
c Account Code
It. Purpose
c. Account Code
all campaign
A
expenses
d. Period Begin Balance
d. Period Begin Balance
$ 100.00
$
CERTIFICATION
1 certify that the Committee or Fund is in compliance with all applicable
visions of Artic 2A, 22B, & 22D -22M of Chapter 163 of
the NC General Statutes and that no funds are commingled with prohib'
E or otter nqn tsclo d funds. 1 further certify that this report
is complete, true and correct and that 1 have been trained by the NC
f fe ion
Stephen D. Martin
01/28/2022
Printed Name of Brener t n
re of Appoi Treasurer
Date
I OR 01FIt'1: 1 Nli ONLY
Date Receised: Employee:
1
Delivery Method
❑ Normal Mail
I
Date Postmarked: Employee:
Date Scanned: 1 Employee:
Registered Mail
Hand Delivered
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.
CRO -1000 NC State Board of Elections August 2008
Amendment
Detailed Summary ❑ Yes ® .a
Use this form to summarize all disclosure reporting forms and to total monetary information.
1. Committee Full Name and Fund if applicable)
2. Tym
of Report
3. ID Number
Committee to Elect Steve Martin
Organizational
Start of Election Cycle: January 1, 2019
Total this
Reporting Period
Total this
Election Cycle
4) ('ash on (land at Start
RECEIPTS.
5) Aggregated Contributions from Individuals
o) 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
IIs) Interest on Bank Accounts
11 b) Contributions from Not -for -Profit Organizations
Ile) Outside Sources of Income
ltd) Legal Expense Fund — Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1110)
(CROJ220)
(CRO -1130)
(CRO -1410)
(CRO -1240)
(CRO-1�
(CRO -1250)
(CRO -1150)
(CRO.1270)
(CRO -1265)
$ 100.00
$
$
$
$ 10.00
$
1083.43
$
$
$
$
$
$
$
$
1SAIGNFINAN("r
$
#N
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines S. 6, 7, 8.9. 10, Ila, 116. 11c. Ildmnllie)
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 -1310)
17) In -Kind Contributions (CRO4510)
$
$
10.00
15.88
$
$
1083.43
15.88
$
$
$
$
$
$
$
$
$
$
$
$
973.43
18)
TOTAL EXPENDITURES (Add lines 13a. 13b, 13c. 14. 15, 16 and 17)
$
15.88
$
989.31
19)
20)
21)
22)
23)
24)
25)
26)
27)
28)
Cash on Hand at End (Add lines 4 and 12logeher, then subtract line 18)
Non -Monetary Gifts Given to Other Committees (CRO -1330)
Outstanding Loans line]. 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 -1710)
Administrative Support (CRO -1710)
Forgiven Loans (CRO -1440)
48 -Hour Notice Reports Sum (CRO -1110)
Contributions to be Refunded (CRO -1115)
$
$
94.12
$
94.12
$
$
$
$
$
$
$
$
$
$
$
$
CRO -1100 VC State Board of Elections August 2008
Amendment
Contributions from Individuals Pg , r , ❑ Nes ® Nn
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. II3 Number
Committee to Elect Steve Martin
3. Contributor Information ❑ Add ❑ Remove
a. Full Nam, Mailing Address & Phone
(include city, amt, & zip)
b. Job Title/Profession
d. Comments
Attorney
Stephen D. Martin
405 Alucio Ct.
Wesley Chapel, NC 28104
c. Employer's Name/Specific Field
Cardinal Innovations Healthcar
e. Election Sum to Date
$ 1083.43
E Prior
g. Account Code
It. Form of Payment
i. In - Kind Description
j. Date (mm/dd/yyyy)
k Amount
❑
A
electronic
_ 12/16/2021
S 10.00
❑8
02
$
-14W❑
$
3. Contributor Information ❑ A `- - tiemove
a. Full Name. Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
Attorney
(continuation)
Stephen D. Martin
405 Alueio Ct.
Wesley Chapel, NC 28104
c. Employer's Name/Specific Field
Cardinal Innovations Healthcar
, Election Sum to Date
$
E Prior
g. Account Code
It. Form of Payment
I. In -Kind Description
I. Date (mm/dd/yyyy)
k Amount
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
it. Comments
e. Employer's Name/Specific Field
e. Election Sum to Date
$
f. Prior
it. Account Code
it. Form of Payment
i. IsKiod Description
j. Date (mm/dd/yyyy)
k .Amount
❑
$
❑
$
❑
$
4. Total only this Page $ 10.00
5. Total of ALL CRO -1210 Pages
(This fine now be on Rne 6 of Dda&d Summary Page CRO -1100)
$ 10.00
CRO -1110 V Slate nOOrd of Illcaian. April 2007
Amendment
Disbursements Pg of ❑ Its p 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. ►D Number
Conunittee to Elect Steve Martin
3. Type of Disbursement Please use separate CRO -1310 form for each twe of Disbursement
® Operanng I penw, p CNt01bl16Vn] to Candidate. PVlllmul Cue1e11pCC� 1:1 t ''nrdn,.cuc.l Pam I "'endnure.
4. Payee Information Lj Add Remove
a. Full Name, Mailing Address & Phone
include city, state, & ri
It. Coordinated Committee Name
d Comments
Target
6350 Weddington Rd.
Wesley Chapel, NC 28104
C. Level Registered (Specify)
❑ Federal ❑ County
❑ State ❑ Municipality.
e. Election Sam to Date
$ 15.88
E Account Code
a. Form of Payment
It. Purpose Code
L Date (mm/dd/yyyy)
j. Amount
it. Required Remarks
A
debit
K
12/16/2021
$15.88
office supplies
4. Payee Information I I Add U Remove
a. Full Name,Mailing Address & Phone
Include city, state, & zip)
b. Coordinated Committee Name
d. Comments
rillrilON CUUNT"
c.Level Registered (SpecifW'-IPAIGN FINA4
❑ Federal County
❑ State ❑ i.ANi4Ary2022
e. Election Sum to Date
f-rrI t.
f. Account Code
g. Form of Payment
It. Purpose Code
L Date (mnddd/yyyy)
j. Amount
L Required Remarks
$
$
4. Payee Information Add Remove
a. Full Name, Vailing Address & Phone
(include cite, state, & zipi
b. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
❑ Federal E] County:
❑ State ❑ Municipality:
a Election Sum to Date
$
C Account Code
g. Form of Payment
It. Purpose Code
L Date (mm/dd/yyyy)
j. Amount
L Required Remarks
$
5. Total only this Pae
$ 15.88
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed SuatmnnPage CRO -1100 if Operating Expenses)
(This line goes in line 13b of Detailed Summon, Page CRO -1100 if Con rib to CandidareVPolUical Conon) ',, $ 15.88
(This line goes in line 13c of Detailed Summmn. Page CRO -I 100 if Coordinated Porn, Evi,enditures)
7. Pu se Codes(List detailed expenditure code in (h,) above
A* - Media R* - Printing C* - Fundraising D - To Another Candidate
E - S:daricc F* - Equipment G - Political Part -N H* - Holding Public Office Expenses
1 - Postage .1 - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* - Other
a Codes require detailed explanation in required remarks field
CRO -13l0 v <t.oe Board of I lecucros December 2009