Palandri,Gina_2021-Year-endAmeadmeot�
Disclosure Report Cover ❑Yes Nn
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
c. ID Number
. Mailing Address (include Clty, State and Zip Code)
d. Date F 11W
lam es t` e�*a Carr -e-
119-6 iZZzz
5 /r & a elv l
e. Phone Number
I Z 296 5 35�
2. Report Year
3. Period Start Date (mm/dd/yy)
4. Period End Date (mmlddlyy)
5. Treasurer Full Name
26 Z2
bI 0 / Z020
{a12/;�->I IZO2 I
GIf�{> )"4&A ^jP9-
6. T e of Committee Check One
9. Type of Report (check
only one type of report
from one category)_
Candidate Campaign ❑ Party
Municipal
State/County
Referendum
PAC ❑ Referendum
❑ Organisational
❑ Organisational
❑ Organisational
❑ Independent Expenditure ❑ Joint Fundraiser
❑ Thirty-five da,
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑ Pre-primary
❑ First
❑ 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. Special Report Name
❑ Other:
Final
❑ special
❑ Year End
❑ Final
8. Number of Fundraisers this Report
❑ Special
11. Account Information
11. Account Information
. Financial institution Full Name
a. Financial Institution Full Name
W, fi
. Purpose
c. Account Code
b. Purpose
c. Account Code
CPpr�twid
GCS
kc -e-1
I��
d. Period Begin Balance
d. Period Begin Balance
-
$ t7��,6 /
-
$
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 lections.
Printed Name of Signer Signature of Appointed Treasurer Date
OR OFFICE USE ONLY I t� /n�
Date Received: (/ .611 ery Method
❑ Normal Mail
Date Postmarked: Employee. istered Mail
d Delivered
Date Scanned: l as Employee: ❑ Electronically Filed
Date Data Entered: Employee: ❑ Signer has not received
mandato training
Please Note: This form cannot be used to amend committee information such as the committwlm S,asurer.
assistant treasurer, custodian of books information, or account informati&i %IPAIGN N,,
You must amend the Statement of Organization (CRO -2100A -E) to make committee
CRO -1000
NC State Board of Elections
August 2008
RECEIVED
- - Amendment
Detailed Summary ❑ ves ® No
Use this form to summarize all disclosure reporting forms and to total monetary information.
1. Committee Full Name and Fund if applicable)
2. Type
of Report
3. ID Number
Gina For Stallings
End of year
9JM 19T
Start of Election Cycle: January 1, 2020
Total this
Reporting Period
Total this
Election Cycle
4)
Cash on Hand at Start
$
575.07
$
1975.00
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
11b) Contributions from Not -for -Profit Organizations
Ile) Outside Sources of Income
11d) Legal Expense Fund — Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1203)
(CRO -1110)
(CRO -1220)
(CRO -1230)
(CRO -7410)
(CRO -1140)
(CRO -1150)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
$
175.00
$
795.00
$
$
750.00
$
$
100.00
$
$
$
$
330.00
$
$
$
$
$
$
$
$
$
$
$
$
12)
13)
14)
15)
16)
17)
TOTAL RECEIPTS (Add lines 5, 6. 7, 8, 9,10, Ila, llb. (Ic, lidand Ile)
URES'
Disbursements
13a) Operating Expenditures (CRO -1370)
13b) Contributions to Candidates/Political Committees (CRO -1370)
13c) Coordinated Party Expenditures (CRO -1310)
Aggregated Non -Media Expenditures (CRO -1315)
Loan Repayments (CRO -1420)
Refunds/Reimbursements From the Committee (CRO -1310)
In -Kind Contributions (CRO -1510)
$
$
750.07
419.49
$
$
1975.00
$ $
$ $
$ $
$ 330.00 $
$ $
$ $
18)
TOTAL EXPENDITURES (Add lines 13a, 13b. 13c. 14, 15. 16 and 17)
$
749.49
$
19)
ADDITIONAL
20)
21)
22)
23)
24)
25)
26)
27)
28)
Cash on Hand at End (,Idllorrs 4and 11 together, thensabtract fitte 18)
INFORMATI
Non -Monetary Gifts Given to Other Committees (CRO -1330)
Outstanding Loans (incl. 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 -1720)
Administrative Support (CRO -1710)
Forgiven Loans (CRO -1440)
48 -Hour Notice Reports Sum (CRO -2110)
Contributions to be Refunded (CRO -1215)
$
$
$
$
$
.58
$
$
$ $
$ IgION COUNTY
$ $
$
CRO -1100 NC State Board of Elections I` 2108
Amendment
Aggregated Contributions from Individuals Page I of I ❑ Yes ® No
Optional form used to report NC Contributions From Individuals of $50 or less
1. Committee Full Name (and Fund ifapplicable)
2. ID Number
Gina For Stallings
9J M 19T
3. Contributor Information
a. Amend
b. Account
Code
c Form of Payment
d. In -Kind
Description
e. Date
mm/dd/
E Amount
❑ Add
GPAB
Card
10/28/2021
$ 25.00
❑ Remove
❑ Add
GPAB
Card
10/21/2021
$ 25.00
F-1 Remove
❑ Add
GPAB
Card
10/19/2021
$ 25.00
❑ Remove
❑ Add
GPAB
Card
10/19/2021
$ 25.00
❑ Remove
❑
GPAB
Card
11/18/2021
$ 25.00
Remove
❑ Remove
❑ Add
GPCH
Check
11/2/2021
$ 50.00
❑ Remove
❑ Add
$
❑ Remove
❑ Add
$
❑ Remove
❑ Add
$
❑ Remove
❑ Add
$
❑ Remove
❑ Add
$
E] Remove
❑ Add
$
F1 Remove
❑ Add
$
❑ Remove
❑ Add
$
❑ Remove
❑ Add
$
❑ Remove
❑ Add
$
❑ Remove
❑ Add
$
❑ Remove
❑ Add
$
❑ Remove
❑ Add
$
❑ Remove
❑ Add
$
❑ Remove
❑ Add
$
❑ Remove
❑ Add
$
Remove
Total only this Page $ iFn3.00
r5Total of ALL CRO -1205 Pages $ 175.00
This fine must be on line S ojDetailed Summary Page CRO.1100)
CRO -1205 NC State Board of Elections-%pril'_u07
Amendment
Disbursements Pg i of + ❑ ves ® 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 9JM18T
3. Type of Disbursement Please use separate CRO -1310 forms for each nwe of Disbursement
® Operating Expenses ❑ Coninbutions to Candidates/Political C'onuniltees ❑ 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
Online
Donation
Fee
For campaign
Act Blue
366 Summer Street
Somerville, MA
02144
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sum to Date
$ 23.30
L Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/yyyy)
I. Amount
IL Required Remarks
GPEX
Card
O
11/1/2021
$18.03
Charges
online donation
GPEX
Card
O
12/012021
$,38
Charges
online donation
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state, & zip)
b. Coordinated Committee Name
d. Comments
Website
For Campaign
e. Election Sum to Date
$ 125.00
Wix
40 Namal Tel Aviv
Israel
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
E Account Code
g. Form of Payment
Is. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
IL Required Remarks
GPEX
Card
O
11/012021
$25.00
Website for
Campaign
GPEX Card
O
12/0 1 /22021
$25.00
Website for
Campaign
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state, & a
b. Coordinated Committee Name
d. Comments
Email for
Campaign
Website
e. Election Sum to Date
$ 30.00
Wix
40 Namal Tel Aviv
Israel
e. Level Registered (specify)
❑ Federal ❑ County:
❑ State ® Municipality:
L Account Code
g. Form of Payment
h. Purpose Code
L Date (mm/ddlyyyy)
I. Amount
k. Required Remarks
GPEX
Card
O
11/012021
$6.00
Email fee
for campaign
GPEX
Card
O
12/012021
$6.00
Email fee
for campaign
5. Total only this Pae
$ 80.41
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed Sumunmy Page CRO -1100 if Operating E)rpenses)
(This line goes in line Iib of Detailed Summan• Page CRO -1100 ifComrib to Candidales/PoRRcal Comm)
(Thu line goes in line Be of Detailed Summon• Page CRO.1100 if Coordinated Pao kilhuiii)l1`1 Y
$ 419.49
7. Purpose Codes(List detailed expenditure code in (h.) above)
A* - Media B* - Printing C* - Fundraising To Another Candidate
E - Salaries F* - Equipment G - Political Party I A N i r; 9nl - 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 -1310 NC State Board of Elections December 2009
Amendment
Disbursements Pg 1 of 2 ® 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. ID Number
Gina for Stallings I 9JM 19T
3. Type of Disbursement Please use separate CRO -1310 fonns for each Iplue of Disbursement
® Operating Expenses ❑ Contributions to Cmdidates/Political Committees ❑ Coordinated Parry Expenditures
4. Payee Information LI Add Lj Remove
a. Full .Name, Mailing Address & Phone
include city, sate, & xi
b. Coordinated Committee Name
d. Comments
Postage
Stamps for Camp
Thank you cards
Postage Stamps
USPS
8300 NE Underground Dr
Kansas City MO
64144
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sum to Date
E Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
L Required Remarks
GPEX
Card
I
10/27/2021
$120,00
Postage Stamps
Campaign Thanks
GPEX
Card
1
10272021
$36.20
Postage Stamps
Postcards
4. Payee Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
include city, state, & ti
b. Coordinated Committee Name
it. Comments
Yardsigns
For campaign
Alpha Graphics
9129 Monroe Road
Charlotte, NC
28270
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ® Municipality:
e. Election Sum to Date
$ 768.99
L Account Code
g. Form of Payment
h. Purpose Cade
i. Date (mm/dd/yyyy)
j. Amount
L Required Remarks
GPEX
Card
B
10/19/2021
$182.88
Yardsign for
campaign
4. Payee Information ❑ Add ❑ Remove
a. Full Same, Mailing Address & Phone
include city, sate, & a
b. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality:
e. Election Sum to Date
$
L Account Code
g. Form of Payment
h. Purpose Code
E Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
$
5. Total only this Pae
$ 339.08
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses)
(This line goin line 13b of Detailed Summar Page CRO -1100 if Coetrib to Candidates/Palideal Comm)
es
(This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures)
$ 419.49
7. Purpose Codes (List detailed expenditure code in (h.) 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 -1310 NC State Board of Elections December 2009
Loan Repayments
Use this form to report payments on an existing loan.
Amendment
Pg of ❑ Yes ® No
1. Committee Full Name and Fund if applicable) 2. In Number
Gina For Stallings 9M 119T
3. Lender Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Comments
Loan
To Campaign
Gina Palandri
1023 Feather Oak Lane
Stallings, NC 28104
c. Original Loan Date
8/4/2021
d. Original Loan Amount
$ 250.00
e. Remaining Loan Balance
E Account Code
g. Form of Payment
h. Date (mm/dd/yyyy)
L Repayment Amount
$ 0
GPWF
Cash
8/4/2021
$ 250.00
S 0
GPWF
Cash
10/06/2021
$ 80.00
3. Lender Information ❑ Add ❑ Remove
a. Full Name. Mailing Address & Phone
(include city, state, & zip)
b. Comments
c. Original Loan Date
d. Original Loan Amount
e. Remaining Loan Balance
L Account Code
g. Form of Payment
h. Date (mm/dd/yyyy)
i. Repayment Amount
$
$
$
$
3. Lender Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, sate, & zip)
b. Comments
c. Original Loan Date
d. Original Loan Amount
$
e. Remaining Loan Balance
L Account Code
g. Form of Payment
h. Date (mm/dd/yyyy)
L Repayment Amount
Total is Page
$ 330.00
r0*th4.
5. Total of ALCRO-1420 Pages
(This One naL uf lx on fine 15 of Derailed Summan, Puge ('RO-1100)
S 330.00
CRO -1420 NC State Board of Elections December 2007