Merrell,Melissa_2021-Year-endAmendment
Disclosure Report Cover p Yea 10 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
. Full Name
e1;5srti 'k
c. tD Nmeber
NI Nlerco.0 UA Cpw4f415'i00 e -r
S S M % V
IL MaBieg Address (Include City, State and 73p Code)
d. Date Filed
Zta03 ,41baMoss Lr..
12/01,/ZOZ
of C J
St-wtl, $ 1 2g (
e. Phone Number
704.8'93• -2192,
Report Year
13. Period Start Date (a�tdtl/yy) 4. Period End Date (mm ddryy)�rer
t2, ern -202,1 Iz 31 hall
Fa0 Name202,1
w K. Merrell
T�Committee (Check Oce) _
.1. of Report (check
only one type of report
from one category)
V Candidate Campaign ❑ Party
Muoidpal
— -
—
13 PAC ❑ Referendum
❑ Organizational
®Organ'rational
❑ Organizational
❑ Independent Expenditure ❑ Joint Fundraiser
❑ Thirty-five day
Quarterly
❑ Pre -referendum
❑ legal Expense Fund
❑ Pre-primary
❑ First
❑ 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
10. Special port Name
❑ Year End
❑ Mid Year
❑ Other
❑ Final
E3Special
® Year End
❑ Final
❑ Special
Number of F Report
_this
11. Account Information
11. Account Information
. Financial Institution Full Name
& Fimmial ImUtuBon Full Name
Trusts -f
TC (Xs
. Purpose
c. Account Code
b. Ptvpose
c Aceortat Cade
2,-5
2513
CrA D it tGy' Ar l •
Cj • lXy 4C -C_+- •
d Period Begin Balance
d. F0 Begin 11111111M1
$ 100. 00
U
S 10.0 0
U
CERTIFICATION
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, we and correct and that I have been trained by the NC State Board of Elections.
�-f
�elssa K. MLrrp'lI .j/llYinr 4 � O1 ZI Lo Lt_
Printed Name of Signer Si ature of Appointed Tre— r� Date
OR OFFICE USE ONLY
r
DeliveMethod
Date Received: Normal Mail
E3 Registered Mail
Date Postmarked: Employee: and Delivered
❑ Electronically Filed
Date Scanned: Employee:
[3 gnernot
Smattdath�
Date Data Entered: Employee: traininetved
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 infotm.TtiaM 1n 13 0 3 6
You must ascend the Statement of Organization (CRO -2100A -E) m make commi c ges.
CRO -1000 Ne stare noaru or erecuom GLUE t U CF7-q,–
3ONVNId NOlVdAVO
AiNnOO NOW
Anse dtnant
Detailed Sulnmaly 0 Yes ;9 No
l Icn thic fnrm to pimmnri7P all dic lnci, rn ino fnrmc and to total tnnnemm infnrmatinn
1. Committee Full Name (and Fund if applicable)
Type of Report
3. ID Number
Me Vt,s6r NwAr �m+ LO,MMi 16;svie'
y ea � �, a
s M7 V v
Start of Election Cycle: January 1,
Reporting
Total this
Period
Total this
Election Cycle
4) Cash on Hand at Start
$ I C)O , O
$
10 O O O
RECEIPTS
$
3q-00
$ 3 q - O O
5) Aggregated Contributions from Individuals
(C)FO.1105)
$
$ 1 Q "7 O�
6) Contributions from Individuals
(CRO -1210)
$
$
7) Contributions from Political Party Committees
(CRO -1120)
$
$
8) Contributions from Other Political Committees
(CRO -1230)
$
$
9) Loan Proceeds
(CRO -1410)
$
$
10) Refunds/Reimbursements to the Committee (CRO -1240)
11) Other Receipt Sources
$
$
Ila) Interest on Bank Accounts
(CRO -1250)
$
7
1lb) Contributions from Not -For -Profit Organizations
(CRO -1250)$
$
$
I lc) Outside Sources of Income
(CRO -125o)
$
$
l Id) Legal Expense Fund -Other Sources
(CRO -1170)
$
$
I le) Exempt Purchase Price Sales (CRO -1265)
12)TOTAL RECEIPTS (Add lines 5,6,7, 8,9, 10,11 a,l l b, l lc, l l d and l le)
$
3
$ 7-7,1. d
EXPENDITURES
13) Disbursements
13a) Operating Expenditures
(CRO -1310)
$
$
13b) Contributions to Candidates/Political Committees
(CRO -1310)
$
$
13c) Coordinated Party Expenditures
(CR04310)
$
$
14) Aggregated Non -Media Expenditures
(CR04315)
$
$
15) Loan Repayments
(CRO -1420)
$
$
16) Refunds/Reimbursements from the Committee
(CRO -1320)
$
$
17) In -Kind Contributions
(CRO -1510)
$
3 t4. D O
$ J ZA ' 00
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$
3 �i C)01
$ Z ' o O
19) Cash on Hand at End ( Add lines 4 and 12 together, then subtract line 181
$
1 OO
$ 0 O ' O
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees
(CRO -1330)
$
1) Outstanding Loans (incl. ones from other campaigns)
(CRO -1430)
$
2) Debts and Obligations owed by the Committee
(CRO -1610)
$
3) Debts and Obligations owed to the Committee
(CRO -1620)
$
N1 PA;
24) Account Transfers Within the Committee
(CRO -1710)
$
5) Administrative Support
(CRO -1710)
$
$
$
1 ,- . !
= L
6) Forgiven Loans (CRO -1440)
7) 48 -Hour Notice Reports Sum
(CRO -2220)
$
$
$
$
8) Contributions to be Refunded (CRO -1215)
CRO -1100 NC State Board of Elections tragus, _'wo
Amendment
Aggregated Contributions from Individuals Page of _ ❑ ties JS No
O tional form used to report NC Contributions From Individuals of $50 or less
P
1. Committee Full Name (and Food if applicable)
2. ID N®ber
�eV,56o., Oe(Cel.l---
CDu l.omr.+.: SS ion eC
Sal M% 1 V
t v�
3. Contributor Information
. Amend
b. Account Code c.
Form of Payment
d. In -Kind Description
e. Date (mmldd(yyyy)
f. Amount
® Add
Z513
E/:st
Vds; t --e.-
12 o7�zaz-1
$ 29•ao
❑ Remove
Eja Add
i
.
5 0 C]
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Ej Add
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
ET—Add
$
❑ Remove
Add
$
❑ Remove
rl—Add
$
❑ Remove
Add
$
❑ Remove
Add
$ UNION C'
❑ Remove
-" ,-MPAID j
Add
FFB 03 (0'lr
❑Remove
Add
$ r
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Total only this Page
$ 3 N • 0 0
5. Total of ALL CFO -1205 Pages
$ 3 Lj
(This fine must be on fine 5 of Derailed Summary Page CRO -/100)
CRO -1205 J Nc Scale roam o
Amendment
In -Kind Contributions Pg _ of _ 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 Full Name (and_ Fund if pplicable) _
Mel;ssc� Merrell u�� ctM„;Ss;�r�
2. ID Number
S TM -7Y I/
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
MCI(55eA Merrrll
woss L-•
2603 Alb4M
c`
�4e it I ..t i I h1 C Z q ( o �
b. Type of Contributor
❑ Individual
Candidate
❑Party
❑PAC
❑ Referendum
❑ Other Receipt Source
c. Comments
d. Election Sum to Date_
$ 26i i) L_-)
n /(Description
tJAwl C�i 1 Gfth tr' t'J S.
f. (mmlddlyyyy)
g. Fair Market Amount
$
tDate
'c -/07'z021
$
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
M e I' t664. Me rr2�tk
2_(oo3 Alba+4-oss LA /
N C 'Z, ? l O-1
(J
b. Type of Contributor
c. Comments
❑ Individual
Candidate
❑ Party
El PAC
❑ Referendum
❑ Other Receipt Source
T
d. Election Sum to Date
$ c 0c)
e. Description
f. Date (mm/ddtyyyy)
g. Fair Market Amount
WWW. M eme l l ;or 13aCC . Co �.
IZ�13�zoz 1
$
$
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state,& zip)
b. Type of Contributor
❑ Individual
❑ Candidate
❑ Party
❑ PAC
❑ Referendum
❑ Other Receipt Source
c. Comments
_iMON COU
CAMPAIGN FI
d. Election Sam
$ -
e. Description
f. Date (mm/dd/yyyy)
g. Fair M
$
$
$
4. Total only this Page
$ 3 Li. c) -C>
5. Total of ALL CRO -1510 Pages
(This line must be on line 17 of Delailed Summary Page CR04100)
'' ff
$ "T '
CRO -1510 NC State Board of Elections December 2007
4 T
4NCL
22
ED