Mills, Parker_2021-Org-DisclosureAmendment /7
Disclosure Report Cover ❑ Yes No I
Use this form for general report and committee information, must be signed and submitted along with other detailed forms.
Do not use this fnrm to undate. information.
1. Committee Information
. Full Name
c. ID Number
_t..�
IPG
-. _
CP J x-Jc e S
. Mailing Address (include City State and Zi Code)
d. Date tied
IIIc N1� A�d kowdl-I70
Zl
e. Phone Number
//
. Report Year
3. teriod Start Date (mould y) 4. Peritiq End gate mm/dd/
5. Treasurer Full rjame
�oz
a0 2 Z -J Al"
d[ 1 /lt'e
41
6. T of Committee Check One
9. Type of Re rt (check only one type of reportftomlohe carega )
altandidate Campaign ❑ Party
Municipal
Statetcounty
Referendum
❑ PAC ❑ Referendum
❑ Organizational
Organizational
❑ Organizational
[3 Independent Expenditure [3 Joint Fundraiser
Thirty-five day
Quarterly
pre -referendum
❑ Legal Expense Fund
❑ Pre-primary
❑ Rist
❑ Final
❑ Pre-election
❑ Pre -runoff
Semi-annual
❑ Second
❑ Third
❑ Fourth
❑ Supplemental Final
❑ Annual
❑ Special
7. Type of Fund (if applicable, check one)
❑ Booster Fund
❑ Building Fund
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
10. S all Report Name
❑ Other:
❑ Final
❑ special
❑ Year End
❑ Final
❑ Special
8. Number of Fundraisers this Report
11. Account Information
11. Account Information
a . Financial Imstitu 'on Full Name
a. Financial
1
i;MPAIGN FINANCE
r / LP�S rf L
h. Purpose
a Account Code
b. Purpose
c. Aec000t Code
n
p�i9
jUL
I (N11'V c e
/
R E C E I VE
d. Period Begin Balance
• Period Begin Balance
$
$
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 INC 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 S Board of Elections.
Printed ame r ner nature ofA oioted Treasurer Darr
FOR OFFICE USE ONL _
Date Received: a I Employee: jfU�fJ Deliver Method
❑ Normal Mail
Registered Mail
Date Postmarked: Employee:
Hand Delivered
Date Scanned: Employee: Electronically Filed
Date Data Entered: Employee: 1] Signer has not received
mandato trotting
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 -21 OOA-E) to make committee changes.
CRO -1000 NC State Board of Elections August 2008
Amendment
Detailed Summary p Yes ❑ No
Use this form to summarize all disclosure revortina forms and to total monetary information
1Commit Full Name (and Fund N a licable)
2. Type of Report
3. II) Number
CLQ ,u( 4 J oc F S
Start of Election Cycle: January 1, y
ReportingPeriod
Total this
Total this
Election Cycle
4) Cash on Hand at Start
$
RECEIPTS
5) Aggregated Contributions from Individuals (CR04205)
6) Contributions from Individuals (CRO -1210)
7) Contributions from Political Party Committees (CRO -1220)
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)
llb) Contributions from Not -For -Profit Organizations (CRO -1250)
1Ic) Outside Sources of Income (CRO -1250)
lld) Legal Expense Fund - Other Sources (CRO -1270)
lle) Exempt Purchase Price Sales (CRO -1265)
$
$
$
$
$
$
$
$
$
$
$
$
ti
$
$
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10,1la, I lb,l Ic,l Id and I le)
$
$
EXPENDITURES
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 -1320)
17) In -Kind Contributions (CRO -1510)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, l6 and 17)
$
66
$
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$
$
ADDITIONAL INFORMATION
20) Non -Monetary Gifts Given to Other Committees (CRO -1330)
21) Outstanding Loans (incl. ones from other campaigns) (CBO -1430)
22) Debts and Obligations owed by the Committee OUNT'CRO-1610)
23) Debts and Obligations owed to the CoN FINAa-1620)
GA
24) Account Transfers Within the Committee O 29211CR0a720)
25) Administrative Support Jul (CR(1710)
26) Forgiven Loans RECEN �eteb-h440)
7) 48 -Hour Notice Reports Sum (CRO -2220)
$
—
$
$
$
$
$
$
$
$
$
$
S) Contributions to be Refunded (CRO -1215)
$
$
CRO -1100 NC State Board of Elections August 2008