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Merrell,Melissa_2021-Org-disclosureDisclosure Report Cover Amend Ye n`jig 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 undate information_ 1. Committee Information . FuB Name c. ID Number sM7y f-1i55� RtrrtU tr co. � ZS6; n . Mailing Addren onclade City, State and Zip Code) d. Date Filed 2-403 Alb&. -ass Ln IZ(f�(zollo 'V C 2-91L e. Phone Number 70`4. 843. 2742- J 2. Report Year 3. Period Start Date (mmld _ 4. Period End Date (mm/ S. Treasurer Full Nttme anal la/4/a-1 11.11& 1,41 1 1`rtu-s-<& J6j%(nin Merrell 6. Type of Committee (Check One) 9. Type of Report (check only one toype of reportfrom one category) Candidate Campaign ❑ Party Municipal te(County Referendum ❑ PAC ❑ Referendum ❑ Organizational Organizational ❑ Organizational ❑ Independent Expenditure ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ Pre-primary ❑ Fust ❑ Final ❑ Pre-election ❑ Pre -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. SpeciWal Re rt Name ❑ Other: ❑ Final ❑ Special ❑ Year End ❑ t h,:,l 8. Number of Fundraisers this Report ❑ Special 11. Account Information 11. Account Information a. Financial Institution Fug Name a. Financial Institution Fug Name . Purpose c. Account Code 2513 b. Purpose pP� w,yr a Account Code 2-513 Ca4n(w.gn Qu}. d. Period Begin Balance d. Period Begin Balance D Qf�f\ $ (� --- AGCOw $ 1 0 IJ . D c) 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. Mzl: ss�. I�1. NIcI•re �( �A�to��r„�,l.�I�„�1 D p Printed Name of Sigmer St natu e cT A inted asu r I 0 to FOR OFFICE USE ONLY j Delivery Method Date Received:t� Employee: 6 rG16 ___� 0 Normal Mail ' Date Postmarked: Employee: O3egistered Mail and Delivered Date Scanned: Employee: ❑ Electronically Filed Date Data Entered: Employee: Sihas not received Please Note: This form cannot be used to amend committee information such as the committc,6,g1d&kWAk6&i, t assistant treasurer, custodian of books information, or account information. 1 6 2021 You must amend the Statement of Organization (CRO -2100A -E) to make committee c s. CRO -1000 NC State Board of Elections R E C E I VELY Amendment Detailed Summary ❑ res ❑ No Tice this form to Al dierinsnre rennrtinn forms and to tntal mnne.tary information 1. Committee Ful ame (and Fund if applicable) 2. Type of Report Intl:06- Merre�1 �+:ss' Or 3. ID Number 57'M 7 V V Start of Election Cycle: January 1, 2[019 Total this Reporting Period 'total this Election Cycle 4) Cash on Hand at Start $ $ 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 11a) Interest on Bank Accounts 11b) Contributions from Not -For -Profit Organizations 11c) Outside Sources of Income 11d) Legal Expense Fund -Other Sources lie) 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--L-67. oc $ $ $ $ $ $ $ $ $ $ $ $ S $ $ $ S $ $ 12) TOTAL RECEIPTS (Add lines 5,6,7,8,9,10,1 laj lb,l lc,l id and I le) $ g7- 00 $ EXPENDITURES 13) Disbursements 13a) Operating Expenditures 13b) Contributions to Candidates/Political Committees 13c) Coordinated Party Expenditures 14) Aggregated Non -Media Expenditures 15) Loan Repayments 16) Refunds/Reimbursements from the Committee 17) In -Kind Contributions (CRO -1310) (CRO -1310) (CRO -1310) (CRO -1315) (CRO -1420) (CRO -1320) (CRO -1510) $ $ $ S $ ti $ S $ S $ S $ �� S 18) TOTAL EXPENDITURES (Add tines 13a, 13b, 13c, 14, 15, 16 and 17) $ 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18 $ I D D - cc $ 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 3) Debts and Obligations owed to the Committee 24) Account Transfers Within the Committee 5) Administrative Support 6) Forgiven Loans 7) 48 -Hour Notice Reports Sum (CRO -1330) (CRO -1430) (CRO -1610) (CRO -1620) (CRO -1720) (Cao -1710) (CRO -1440) (CRO -2220) $ $ $ $ $ EDU $ $ $ 8) Contributions to be Refunded (CRO -1215) $ CRO -1100 NC State Board of Elections r! L u ` .Ausa,i'O LL Amendment .... Contributions from Individuals Pg or ! ❑ res ❑ No Use this form to report individual contributions over $50 of contributions under S50 it Ionn CRO 1205 is not used 1. Committee Full Name (and Fund if applicable) .t It -56 6 -Me r e 11 CorA K, 55 i Or�e_r- 2. ID Number ,7 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip).� nA - - M e. I' SS 0. M e are, It 2-(,03 Alba�ss Lr S�0.11; 9s) r1L 2 IOy b. Job Title/Profession - sz� d. Comments TP w: s% c. Employer's Name/Specific Field J04- l� 'Er floyt4 e. Election Sum to Date Is ldo.00 f. Prior ❑ g. Account Code h• Form of Paymeal i. In -Kind Description '. Date (mmtddfyyyy) ti/f./zoal it. Amount $ 100.00 2513 CAC-- ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, ;flailing Address & Phone (include city, state, & zip) 11 Met'ss0. IV IBff-211 Z(oo3 A16, {.toss Ln NC, 2%toe( b. Job Title/Profession d. Comments W c. Employer's Name/Specific Field 1pt'`� r—Gle— e. Election Sum to Dale L, play4'ak $ I g r7 L) C) -- f. Prior E] Account Code h. Form of Payment i. In -Kind Description J. Date pnuddd/yyyy) k Amount $ 97-60 Ill. ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Pull Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments c. Employer's Name/Spedric Field e. Election Sam to Date $ r.Prior g. Account Code h. Form of Payment 1. In -Kind Description J. Date (mmldd/yyyy) it. Amount ❑ $ ❑ $ 4. Total only this Page S 9 ' 7 . o 5. Total of ALL CRO -1210 Pages (This line must be on line h ofDernited summary Page CRO -1100) $ I g7- v CRO -1210 NC Siztc B3 and o(Flectwn. April 2007 A niendment� In -Kind Contributions Pit I of _L_ ❑ , e, ❑ No Use this form to report non-monetarycontributions, donations, goods or services provided to the committee ur ! und. Use CRO -1215 if In -Kind Contributions were or will be refunded within 7 days. Z. I f Number McCssa- ss4one- SSM 3. Contribti ., _ . _ .... ..:. ,, a, ❑ Remove , a. Full Name, Mlailing Address & Phone b. Type of Contributor c. Comments (include city, state, & zip) ❑ Individual (V1t It s s ^ MtcY C1� Candidatert�nJ! Party {�y T Ci 2(eo-3 ❑ PAC d. Election Surn to Date C .Z G' O !J LI ❑ Referendum r7T f . OV is ✓Y 1 ❑ Other Receipt Source e. Description L Date (mm/dd/yyyy) g. Fair Market Amount if Z40 2, 1 $ T7.0 0 $ $ 3. Contributor Information ❑ Add OR=ove a. Full Name, Mailing Address & Phone b. Type of Contributor c Comments (include city, state, & zip) ❑ Individual _ --- ❑ Candidate ❑ Party ❑ PAC ❑ Referendum d. Election Sum to Date ❑ Other Receipt Source $ e. Description L Date(mmIdd/yyyy) g. Fair Market Amount $ $ s 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone b. Type of Cnntribul(r C. ConunentI (include city, state, & zip) ❑ Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum d. Election Sum to Date ❑ Other Receipt Source $ , . Description _ L Dale (mm/ddlyyyy) (XIj#uket Atpoeot = $;. } s 4. Total only this Page 5. Total of ALL CRO -1510 Pages isAW f (This line mast be on fine 17 of Detailed Strarmary Page CRO -Hoo) CRO -1$10 NC State Board of Elections December 2007