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Palandri,Gina_2021-PreElectionReportAmendment Disclosure Report Cover 1 ❑ \es ® 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 Gina For Stallings 91M19T b. Malting Address (include City, State and Zip Code) d. Date Filed 1023 Feather Oak Lane 10/24/2021 Stallings e. Phone Number NC 6122965356 28104 2. Report Year 3. Period Start Date (mm/dd/yy) 4. Period End Date 5. Treasurer Full Name mm/dd Gina 2021 07/26/2021 10/18/2021 Palandri 6. Type of Committee (Check One) 9. Type of Report check only one e o re ort om one category) ® Candidate Campaign ❑ Party Municipal State/County Referendum ❑ PAC ❑ Referendum -9r5emmtiort3r ❑ Organizational ❑ Organizational Independent ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Expenditure ❑ Legal Expense Fund ❑ Pre-primary ® Preelection ® First ❑ second ❑ Final ❑ supplemental Final 7. Type of Fund (fopptioubk. check ore) ❑ "Booster Fund" ❑ Building Fund ❑ Pre-mrmff ❑ Third ❑ Annual semi-annual ❑ Fourth ❑ special ❑ Mid Year Semi-annual 10. Special Report Name ❑ Other: ❑ Year End ❑ Mid Year ❑ 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 Fargo b. Purpose c. Account Code It. Purpose c. Account Code Campaign W FGP UNION COUNTY Business CAMPAIGN FINANCE Begin Balance Account d. Period Begin Balance d. Period $ $ 0 OCT 2 5 2021 CERTIFICATION vQi l l e (+ Ie EQ I certify that the Committee or Fund is in compliance with all applicable prove 2213, & 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 1 have been trained by the Sta Board of Elections. Gina M.Palandri 10/24/2021 Printed Name of Signer signature of Appoin d Treasurer Date FOR OFFICE USE ONLY Delivery Method / Date Received: Employee: ❑ Normal Mail Registered Mail Date Postmarked: Employee: Hand Delivered Electronically Filed Date Scanned: Employee: ❑ Signer has not received mandatory training Date Data Entered: Employee: 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 Mug Amendment Detailed Summary ❑ Yes ® No Use this form to summarize all disclosure reporting forms and to total monetary information. 1. Committee Full Name and Fund ifapplicable) 2. Type of Report 3. ID Number Gina For Stallings Pre Election 91M19T Start of Election Cycle: January 1, 202® Total this Reporting Period Total this Election Cycle 4) Cash on Hand at Start $ 0 $ 5) 6) 7) 8) 9) 10) 11) Aggregated Contributions from Individuals Contributions from Individuals Contributions from Political Party Committees Contributions from Other Political Committees Loan Proceeds Refunds/Reimbursements To the Committee Other Receipt Sources Ila) Interest on Bank Accounts Ilb) Contributions from Not -for -Profit Organizations Ile) Outside Sources of Income 11d) Legal Expense Fund — Other Sources 11 e) Exempt Purchase Price Sales (CRO -1205) (CRO -1210) (CRO -1220) (CRO -1230) (CRO -1410) (CRO -1240) (CRO -1250) (CRO -1250) (CRO -1250) (CRO -1170) (CRO -1265) I $ 720.00 $ 720.00 $ 750.00 $ 750.00 $ 100.00 $ 100.00 $ $ $ 330.00 $ 330.00 $ $ $ $ $ $ $ $ $ LS $ $ 12) TOTAL RECEIPTS (Add lines 5.6, 7, 8, 9, 10, Ila, Ilb, 11c, Ild and Ile) EXPEND 13) Disbursements 13a) Operating Expenditures (CRO -1310) 13b) Contributions to Candidates/Political Committees (CRO.1310)$ 13c) Coordinated Party Expenditures (CRO-1310)CAVPAIGN 14) Aggregated Non -Media Expenditures (CRO-1315)'OCT 15) Loan Repayments (CRO -1420) 16) Refunds/Reimbursements From the Committee (CRO -1320) 17) In -Kind Contributions (CRO -1510) $ 1900.00 $ 1900.00 $ 1224.93 $ 1224.93 FINANCE $ 2 5 2021 $ $ $ $ $ $ 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c.14. 15,16 and 17) $ 1224.93 $ 1224.93 19) Cash on Hand at F.nit ( IddLnev4and 12 together. then subtract line 18) O $ 675.07 $ 675.07 20) 21) 22) 23) 24) 25) 26) 27) 28) Non -Monetary Gifts Given to Other Committees Outstanding Loans (incl. ones from other campaigns) Debts and Obligations owed By the Committee Debts and Obligations owed To the Committee Account Transfers Within the Committee Administrative Support Forgiven Loans 48 -Hour Notice Reports Sum Contributions to be Refunded (CRO -1330) (CRO -1430) (CRO -1610) (CRO -1620) (CRO -1720) (CRO -1710) (CR04440) (CRO -2220) (CRO -1215) $ $ $ $ $ $ $ $ $ $ $ $ $ CRO -1100 NC State Board of Elections August 2008 Amendment Aggregated Contributions from Individuals Page I of 2 ❑ Yes ® No Optional form used to report NC Contributions From Individuals of $50 or less 1. Committee Full Name and Fund if applicable) 2. In Number Gina For Stallines - 9J M 19T 3. Contributor Information a. Amend b. Account Code c. Form of Payment d. In -Kind Description e. Date mm/ddt L Amount ❑ Add GPAB Card 8/12/2021 $ 50.00 ❑ Remove ❑ Add GPAB Card 8/10/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 8/10/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 9/18/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 10/16/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 10/15/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 10/15/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 10/14/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 10/14/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 10/14/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 10/14/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 10/12/2021 $ 50.00 ❑ Remove ❑ Add GPAB Card 10/12/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 10/11/2021 $ 20.00 ❑ Remove ❑ Add GPAB Card 10/10/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card10/10/2021 UNION COU $ 25.00 ❑ Remove F� Add GPAB Card CAMPA 10/09/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 10/09/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 10/05/2021 $ 25.00 ❑ Remove ❑ Add GPAB Carel 10/05/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 10/05/2021 $ 50.00 ❑ Remove ❑ Add GPAB Card 10/05/2021 $ 25.00 ❑ Remove 4. Total only this Page $ 620.00 5. Total of ALL CRO -1205 Pages (This line must he on fine 5 of Detailed Summary Page CRO -1100) $ 720.00 CRO -1105 NC State Board of Elections April AM Amendment Aggregated Contributions from Individuals Page 2 of 2 ❑ Yes ® No Optional form used to report NC Contributions From Individuals of $50 or less 1. Committee Full Name and Fund if applicable) 2. In Number _ Gina For Stallines 9JM 19T 3. Contributor Information a. Amend b. Account Code c. Form of Payment d. In -Kind Description e. Date mm/dd/ f. Amount ❑ Add GPAB Card 8/12/2021 $ 50.00 E] Remove ❑ Aad GPAB Card 8/10/2021 $ 25.00 ❑ Remove ❑ Add GPAB Card 8/10/2021 $ 25.00 ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add I INION COUNTY $ ❑ Remove ❑ Add 2 5 2021 $ F1Remove ❑ Add ON $ ❑ Remove ❑ Add RECEIVED$ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove 4. Total only this Page $ 100.00 5. Total of ALL CRO -1205 Pages (This fine mast be on fine 5 of Detailed Summary Page CR0.1100) $ 720.00 CRO -1105 NC State Board of Elections Apnl 2007 Amendment Contributions from Political Party Committees Pg i of i ❑ Yes ® No Use this form to report contributions from a political party 1. Committee Full Name and Fund if applicable) 2. ID Number Gina For Stallinss - 9JM 19T 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, smte, & zip) b. Comments Union County Democratic Committee PO Box 81 Monroe NC 28111 c. Election Sum to Date $ 100.00 d. Account Code e. Form of Payment I. In -Kind Description g. Date mm/dd/ It. Amount GPCD Check 09/22/2021 $ 100.00 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Comments c. Election Sum to Date d. Account Code e. Form of Payment E In -Kind Description g. Date mm/dd It. Amount 3. Contributor Information ❑ Remove Go a. Full Name, Mailing Address & Phone CAMPAIGN FINANC _ (include city, state. &zip) b. Comments OCT 2 5 2021 RECEIVEDc. Election Sum to Date $ d. Account Code e. Form of Payment E In -Kind Description g. Date mm/dd It. Amount $ 4. Total only this Page $ 100.00 5. Total of ALL CRO -1220 Pages (This fine must be on fine 7 ojDdaifed Sunmmy Page CR0.1100) $ 100.00 Amendment Contributions from Individuals Pg i of z ❑ 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 Gina For Stallings 9JM19T 3. Contributor Information ® Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & rip) b. Job Title/Profession d. Comments Travel Agent Denise Birckbichler 4921 Whitmore Pond Lane Charlotte NC 28270 a Employer's Name/Specific Field Dream Vacations e. Election Sum to Date $ 100.00 f. Prior g. Account Code It. Form of Payment 1. In -Kind Description j. Date (mm/dd/yyyy) L Amount ❑ GPAB Card 08/10/2021 $ 100.nn ❑ $ ❑ $ 3. Contributor Information ® Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & tip) It. Job Title/Profession d. Comments e. Election Sum to Date Sales Danielle Birckbichler 728 E 8th street Charlotte NC 28202 c. Employer's Name/Specific Field Zebra Technologies $ 100.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) h. Amount ❑ GPAB Card 09/18/2021 $ 100.00 ❑ $ ❑ $ 3. Contributor Information ® Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) It. Job Tide/Profession d. Comments Retail Dalton Beauchamp 16922 T Ave Woodward JA UNION C 50276 CAMPAIGN 50 c. Employer's Name/Specific Field spar s I Y FINANCE e. Election Sum to Date $ 100.00 f. Prior g. Account Code It. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k Amount ❑ GPAB Card RECEIVED 10/16/2021 $ 100.00 ❑ $ ❑ $ 4. Total only this Page $ 300.00 5. Total of ALL CRO -1210 Pages (This fine must be on fine 6 ojDetailed Summary Page CRO -1100) $ 750.00 CRO -1210 NC State Board of Elections April 2007 Amendment Contributions from Individuals Pg 2 of z ❑ 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)--F2—.I—]D Number Gina For Stallings 9JM 19T 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Nailing Address & Phone (include city, state, & zip) b. Job Tide/Profession d. Comments Not Employed Retired Peter Burk 1133 Warburton Ave Yonkers NY 10701 c. Employer's Name/Specific Field Physician e. Election Sum to Date $ 250.00 E Prior g. Account Code h. Form of Payment 1. In -Kind Description j. Date (mm/dd/yyyy) K Amount ❑ GPAB Card 10/11/2021 $ 250.00 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Nailing Address & Phone (include city, state, & rip) b. Job Title/Profession d. Comments Not Employed a Election Sum to Date Gloria Overeash 1642 Upper White Store Lane Peachland NC 28133 c. Employer's Name/Specific Field $ 200.00 E Prior I g. Account Code h. Form of Payment I. In -Kind Description j. Date (mm/dd/yyyy) L Amount ❑ GPAB card 10/07/2021 $ 200.00 ❑ $ ❑ S 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Nailing Address & Phone (include cih. state, & zip) b. Job Title/Profession d. Comments UNION COU NiY c. Employer's Name/Specific Field e. Election Sum to Date $ f. Prior g. Account Code It. ForCDM# d Description j. Date (mm/dd/yyyy) L Amount ❑ OCT 2 5 2021 $ ❑$ ❑RE$ 4. Total only this Page $ 450.00 5. Total of ALL CRO -1210 Pages (This line must be on line 6 of Detailed Summary Page CR0.1100) $ 750.00 CRO -1210 NC State Board of Elections April 2007 Amendment Disbursements Pg I of 4 ❑ Yes ® No Use this form to report expenditures from the committee for: operating expenses, contributions to candidate/political committees and coordinated parry expenditures. 1. Committee Full Name and Fund if applicable) 2. ID Number Gina For Stallin_s 9.)M 19T 3. Type of Disbursement Please use separate CRO -1310 forms for each type of Disbursement ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information Lj Add Lj Remove a. Full Name, Mailing .Address & Phone include city, state. & a b. Coordinated Committee Name d. Comments Domain Name Go Daddy 14455 North Hayden Rd Scottsdale, AZ 85260 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Elation Sum to Date $ 21.75 C Account Code I g. Form of Payment h. Purpose Code E Date (mm/dd/yyyy) j. Amount L Required Remarks GPEX Card O 7/23/2021 $21.75 Domain Name 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state,&ri b. Coordinated Committee Name d. Comments Website Wix 40 Namal Tel Aviv Israel c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Elation Sum to Dale $ 75.00 E Account Code g. Form of Payment It, Purpose Code i. Date (mm/dd/yyyy) J. Amount it. Required Remarks GPEX Card O 8/1/2021 $25.00 Website GPEX Card O 9/1/2021 $25.00 Website 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address &Phone include city, state, & zip b. Coordinated Committee Name d. Comments Website Wix 40 Namal Tel Aviv 0�T 2 5 Israel RECEI\1 ED c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Elation Sum to Date $ 75.00 L Account Code g. Form of Payment Is. Purpose Code I. Date (mm/ddlyyyy) I. Amount L Required Remarks GPEX Card O 10/01/2021 $25.00 Website 5. Total only this Pae $ 96.75 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summon' Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Detailed Sumon• Page CRO -1100 if Cowell, to CandidateslPolidcal Comm) m (This line goes in line 13c of Detailed Summary• Page CRO -1100 if Coordinated Parry Expenditures) $ 1224.93 7. Purpose Codes(List detailed expenditure code in above) A* - Media B* - Printing C* - Fundraising D - lb Another Candidate E - Salaries F* - Equipment G - Political Part} H* - Holding Public Office Expenses 1 - Postage J - Penalties K* -Office Expenses Q* - Donation to Legal Expense Fund O* - Other * Codes require detailed explanation in required remarks field (k CRO -1310 NC Stale Board of Elections December 2009 Amendment Disbursements Pg 2 of 4 ❑ Yes ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated oartv expenditures. 1. Committee Full Name and Fund if applicable) 2. ID Number Gina For Stallings 9JM19T 3. Type of Disbursement Please use se urate CRO -1310 fonfis for each type of Disbursement ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information LI Add Lj Remove a. Full Name, Mailing Address & Phone include city, state, & a b. Coordinated Committee Name d. Comments Logo Design Feed The Dog Creative Andrea Volmar 2500 Lee Ave North Golden Valley MN 55422 c. Level Registered (Specify) ❑ Federal ❑ county: ❑ state ® Municipality: e. Election Sum to Date $ 300.00 f. Account Code g. Form of Payment It. Purpose Code i. Date (mm/dd/yyyy) j. Amount IL Required Remarks GPEX Card O 09/01/2021 $300.00 Logo design 4. Payee Information El Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & ri b. Coordinated Committee Name d. Comments T shirts Zazzle.com 811 Sandhill Road Reno, Nevada 89521 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: a Election Sum to Date $ 119.67 L Account Code g. Form of Payment It. Purpose Code i. Date (mm/dd/yyyy) j. Amount L Required Remarks GPEX Card O 8/11/2021 $119.67 Tshirts $ 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & ri b. Coordinated Committee Name d. Comments printed masks V istaprint I NANC E 275 Wynan Street Wartham MA 02451 L y 2021 1. I R CEIVECI c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 87.11 E Account Code I g. Form of Payment It. Purpose Code t. Date (mm/dd/yyyy) I j. Amount k. Required Remarks GPEX Card O 8/2/2021 $87.11 $ 5. Total only this Pae $ 506.78 6. Total of ALL CRO -1310 Pages (This line goes in line Iia of Detailed Summaq Page CRO -1100 if Operating Expenses) (This line goes in line lab of Detailed Summon• Page CRO -1100 if Contrib to CandidatexlPalitical Comm) (This line goes in line lac of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) $ 1224.93 7. Purpose Codes(List detailed expenditure code in above A* - Media B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses 1 - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* - Other * Codes require detailed explanation in required remarks field k CRO -1310 NC State Board of Elections December 2009 Amendment Disbursements Pg 3 of 4 ❑ Yca ® 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. ID Number Gina For Stallings 9JM19T 3. Type of Disbursement Please use separate CRO -1370 form for each type of Disbursement ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Pam' Expenditures 4. Payee Information Add Lj Remove a. Full Name, Mailing Address & Phone include city, state, & a It. Coordinated Committee Name it. Comments Online Donation Merchant Act Blue 366 Summer Street Somerville MA 02144 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 4.89 E Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks GPEX Card O 9/01/2021 $3.01 Charges GPEX Card O 10/01/2021 $1.88 Charges 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state,&ri b. Coordinated Committee Name d. Comments online 3d Merchant fees Vantiv 8500 Governors Hill Drive Cin Ohio 45249 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 5.18 f. Account Code g. Form of Payment It. Purpose Code i. Date (mm/ddlyyyy) j. Amount k. Required Remarks GPEX Card ) 09/09/21 $5.18 4. Payee Information Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state,&zi --'t)NIY It. Coordinated Committee Name d. Comments email fee Wix � rINA 40 Namal Tel Aviv GFR11'•'•" Israel ocL 25 2021 RECEIVED c. Level Registered (Specify) ❑ Federal ❑ County: E] state N Municipality: e. Election Sum to Date $ 6.00 L Account Code g. Form of Payment h. Purpose Code I i. Date (mm/dd/yyyy) j. Amount k. Required Remarks GPEX Card O 10/12/2021 $6.00 email fee 5. Total only this Pae $ 16.07 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in One lib of Detailed Summary Page CR0.1100 ifContrib to Candidates/Palifical Conus) (This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) $ 1224.93 7. Purpose Codes(List detailed expenditure code in above A* - Media B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* - Other * Codes require detailed explanation in required remarks field (k CRO -1 410 NC: State Board of Elections December 2009 Amendment Disbursements Pg 4 of 4 ❑ Yes ® 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) 2.1D Number Gina For Stallings I 9M19T 3. Type of Disbursement Please use separate CRO -1310 fonsts for each type of Disbursement ® Operating Expenses ❑ Contribution, to C a ndidates/Political Committees ❑ Coordinated Pam Expenditures 4. Payee Information Add El Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name it. Comments Printing Yardsigns Cards Alphagraphics 9129 Monroe Rd Charlotte, NC 28270 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 586.11 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount L Required Remarks GPEX Card B 10/13/2021 $243.53 printing GPEX Card B 10/04/2021 $162.58 printing 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name it. Comments Printing Alphagraphics 9129 Monroe Rd Charlotte, NC c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date $ 586.11 f. Account Code g. Form of Payment Is. Purpose Code i. Date (mm/dd/yyyy) j. Amount L Required Remarks GPEX Card B 10/06/2021 $100.00 Printing GPEX Cash B 10/06/2021 $80.00 Printing 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name it. Comments Plastic Supply Boxes for campaign cards/ Hand San Dollar tree ,; p,nn OU 4508Old Monroe ,,/s,;;p.,'.„!J FINANCE Indian Trail NC 28079 OCT 25 2021 ivEc c Levell Registered (Specify) ❑ Federal ❑ County: ❑ State ® Municipality: e. Election Sum to Date I $ 12.81 L Account Code g. Form of syment h. Purpose Code 1. Date (mm/ddlyyyy) j. Amount k. Required Remarks GPEX Card O 10/08/2021 $12,81 supplies GPEX Card O 10/08/2021 $6.41 Hand Sanitizer 5. Total only this Pae $ 605.33 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summar' Page CRO.1100 if Operating Expenses) (This line goes in line 13b of DerailedSumPage CRO -1100 ifComrib to Condldates/Poliacat Conn) (This line goes in line 13c of Detailed Summon• Page CRO -1100 if Coordinated Party Expenditures) $ 1224.93 7. Purpose Codes(List detailed expenditure code in above) A* - Media B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses I - Postage 3 - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* - Other * Codes require detailed explanation in required remarks field k CRO -1 i10 NC State Board of Elections December 2009 Amendment Loan Proceeds Pg 2 of 2 ❑ les ® No Use this form to report proceeds from a loan and loan endorser's information A loan proceeds statement must accompany each loan that is from an individual 1. Committee Full Name and Fund if applicable) 7772. ID Number Gina For Stallings 9JM 19T 3. Lender Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & tip) It. Job Title/Profession d. Comments Merchandiser Campaign Expenses Gina Palandri 1023 Feather Oak Lane Stallings, NC 28104 e. Start Date (mm/dd/yyyy) c. Employer's Name/Specific Field 10/6/2021 RMS Merchandising E End Date (mm/d(l/yyyy) g. Rate h. Security Pledged !.Account Code j. Form of Payment L Amount 0 % Cash $ 80.00 1. Full Name of fending Institution m. Loan Number 4. Endorsers/Makers (The people who guarantee the loan.) a. Full Name, Mailing Address & Phone (include city, state, & tip) b. Job Title/Professiou c. Employer's Name/Specific Field d. Percentage e. Amount a. Full Name, Mailing Address & Phone (include city, state, & tip) It. Job Tide(Profession c. Employer's Name/Specific Field d. Percentage e. Amount a. Full Name, Mailing Address & PhoneUNTY (include city, state, &tip) UNOp ION gNCE b. Job Title/Profession c. Employer's Name/Specific Field OCT 2 5 2021 RECEIVEDd. Percentage e. Amount % $ a. Full Name, Mailing Address & Phone (include city. state. & zip) It. Job Title/Profession c. Employer's Name/Specific Field d. Percentage e. Amount $ 5. Total of ALL CRO -1410 Pages (Tkia Raenmst be on line 9 ojDetailed Summary Page CRO -1100) $ 330.00 Loan Proceeds Amendment Pg 1 of 2 ❑ Yes ® No Use this form to report proceeds from a loan and loan endorser's information A loan proceeds statement must accompany each loan that is from an individual 1. Committee Full Name and Fund if applicable) 2. tD Number Gina For Stallings 9JM19T 3. Lender Information ® Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & tip) b. Job Title/Profession d. Comments Merchandiser Campaign Expenses Gina Palandri 1023 Feather Oak Lane Stallings NC 28104 e. Start Date (mm/dd/yyyy) c. Employer's Name/Specific Field 08/04/2021 RMS Merchandising E End Date (mm/dd/yyyy) g. Rate It. Security Pledged i. Account Code j. Form of Payment h. Amount 0 % Cash $ 250.00 1. Full Name of Lending Institution m. Loan Number 4. Endorsers/Makers (Thepeople who guarantee the loan) a. Full Name, Mailing .Address & Phone (include city, state, & zip) b. Job Title/Profession c. Employer's Name/Specific Field d. Percentage C. Amount a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession c. Employer's Name/Specific Field d. Percentage e. Amount % $ a. Full Name, Mailing Address & Phone (include city, state, & zipl IIdION COUNTY b. Job Tide/Profession c. Employer's Name/Specific Field _ OCT 2 5 2021 RECEIVEDd. Percentage e. Amount % $ a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession c. Employer's Name/Specific Field d. Percentage e. Amount % $ 5. Total of ALL CRO -1410 Pages (This line must be on line 9 of Detailed Summary Page CRO. 1100) $ 330.00 CRO -1410 NC State Board of Elections April 2007 VOTE �Ir NORTH CAROLINA STATE BOARD OF ELECTIONS Loan Proceeds Statement This Statement is used to report detailed information about a new loan and is required to accompany the Loan Proceeds Form in the report for which the loan is initially disclosed. If the loan is from an individual, the lender's signature is required on this form. This Statement is to be filed with the Election Board where the committee's reports are filed. • Name of committee to receive loan: Gina For Stallings • Person or committee to make loan: Gina Palandri • Date of loan to committee: 10/06/2021 • Name of lending institution (source): Cash • Amount of loan: 80.00 • Description (if in-kind loan): For campaign related expenses • Names of all parties responsible for payment of loan (guarantors): NA ',!or! • Period of loan: NA • Rate of interest of loan: 0% RECEIVED • Security pledged for loan: 0% I, 6/AR acknowledge that all of the information (Person lending money to committee) provided is complete, true, and accurate. I further understand I may not forgive a loan that has an out ending balance to any source. Signature of Treasurer of Committee CRO -6/00 Loan Proceeds Statement o/as/dazl 'a Slaaa� Date Signed I'dVOTOENOPTH CAROLINA STATE BOARD OF ELECTIONS Loan Proceeds Statement This Statement is used to report detailed information about a new loan and is required to accompany the Loan Proceeds Form in the report for which the loan is initially disclosed. If the loan is from an individual, the lender's signature is required on this form. This Statement is to be filed with the Election Board where the committee's reports are filed. • Name of committee to receive loan: Gina For Stallings • Person or committee to make loan: Gina Palandri • Date of loan to committee: 08/04/2021 • Name of lending institution (source): Cash • Amount of loan: 250.00 • Description (if in-kind loan): For campaign related expenses • Names of all parties responsible for payment of loan (guarantors): NA cQUNr! .. • Period of loan: NA cAMFaIGN • Rate of interest of loan: 0% OCT 2 5 Z�YZI • Security pledged for loan: 0% RE(:EIVE I, 1,4/,4 O717L"Vyl� acknowledge that all of the information (Person lending money to committee) provided is complete, true, and accurate. I further understand I may not forgive a loan that h s an out anding balance to any source. / o �, Signature of Lender Date Signed A� /Odd50 Signature of Treasurer of Committee Date Signed CRO -6100 Loan Proceeds Statement