JPropst-2015 35 Day Report,, Amendment
bisclOsure Report Cover ❑ Yea ® No
Use this forth 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
Janice G. Propst
SJMR33
b. Malting Address (include City. State and 73p Code)
REGEiVED
d. Date Filed
531 Weddington Rd.
Matthews, NC
SEP 2 8 2015
07/06/2015
Phone Number
28104e.
Union Co. Board o1 Elections
704 849-6759
2. Report Year
3. Period Start Date (mmiddiyy)
mini riod End Date
5. Treasurer Full Name
2015
07 06 201
09/22/2015
Janice G. Props(
6. Type of Committee Check One
9. Type
of Report (check only
one type of report om one category)
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
❑
Organizational
❑ Organizational
❑ Organizational
Independent Joint FundraiserThi
❑ Expenditure ❑
®
five de
nY- Y
Quarterly
E] Pre -referendum
❑ Legal Expense Fund
❑
❑
Pre-primary
Pre-election
❑ First
❑ Second
❑ Final
❑ Supplemental Final
7. Type of Fund (iifapptioable, deck one)
❑ "Booster Fund"
❑ Building Fund
❑
Pm-nmoff
❑ Third
❑ Annual
Semi-annual
❑ Fourth
❑ Special
❑
Mid Year
Semi-annual
® Other:
❑
Year End
❑ Mid Year
10. Special Report Name
❑
❑
Final
Special
❑ Year End
❑ Final
❑ Special
withdrew
Threshold 08/19
2015
8. Number of Fundraisers this Report
0
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Poll Name
Community One Bank N.A.
b. Purpose
c. Account Code
b. Purpose
c. Account Code
Campaign
Funds
JGP
d. Period Begin Balance
it. Period Begin Balance
$ 0.00
$
CERTIFICATION
1 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 tate Board of E ell ns.
Janice G. Propst
09/25/2015
Printed Name of Signer
ignamre of AitionaW Treagurcr
Date
FOR OFFICE USE ONLY
Date Received: a g �s
Employee:kjjAtv�,
Delivery Method
❑ Normal Mai)
Date Postmarked: N A
Date Scanned: 013()Zl S
Employee:
Employee: 1"M
p
❑ Registered Mail
AW Hand Delivered
El Electronically Filed
❑ Signer has not received
Date Data Entered:
Employee:
mandatory training
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 Organintion (CRO -2 100A -E) to make committee changes.
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 if applicable)
2.
of Report
3. H) Number
Committee To Elect Janice Propst
35 Dal
SJMR33
Start of Election Cycle: Januar) 1,
1, 2011
this
Reporting Period
Total this
Election Cycle
4)
Cash on Hand at Start
$
0-00
$
RECEIPTS
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 -mos)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CRO -1140)
(CRO -1250)
(CRO -1250)
(CRO -1150)
(CRO.1270)
(CRO -1265)
$
400.00 $
400.00
$ 1900.00 $
1900.00
$ $
$ $
$ $
$ $
$ $
$
$
$ ^101) CO. Eoard of
$ $
12)
13)
14)
15)
16)
17)
TOTAL RECEIPTS (Add aess, 6, 7.8.9. 10, Ila, 116, lie, Ildandlie)
Disbursements
13a) Operating Expenditures (CRO -1310)
13b) Contributions to Candidates/Political Committees (CRO.1310)
13c) Coordinated Party Expenditures (CRO -1310)
Aggregated Non -Media Expenditures (CRO -1315)
Loan Repayments (CRO -1420)
Refunds/Reimbursements From the Committee (CRO -1320)
In -Kind Contributions (CRO -190)
$
2300.00
$
2300.00
$ 1432.63 $
1432.63
$ $
$ $
$ $
$ $
$ $
$ $
18)
TOTAL EXPENDITURES (Add saes 13a, 136, 13c, 14, 1S, 16 and 17)
$
$
19) Cash on Hand at End (Add Moes 4and 12togedwr. then sabvactlae 18)
ADD AL INFON
$
867.37
$
867.37
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
(CR&1330)
(CRO -1430)
(CRO -1610)
(CRO -1620)
(CRa1720)
(CRO -1710)
(CR0-1440)
(CRO -2200)
(CRQ1215)
$
$
$
$
$
$ $
$ $
$ $
$ $
CRO -1100 NC State Board of Elections August 2008
Amendment
Aggregated Contributions from Individuals Page t of I ❑ A'es ®
Optional form used to report NC Contributions From Individuals of $50 or less
1. Committee Full Name and Fund if a livable
2. ID Number
Committee To Elect Janice Props)
SJM R33
3. Contributor Information
a. .Amend
b. Account
Code
c. Form of Payment
d. In -Kind
Description
e. Date
mm/d
E Amount
® Add
JGP
check
07/31/2015
$ 50.00
Remove
® Add
JGP
check
07/31/2015
$ 50.00
❑ Remove
® Add
JGP
check
07/25/2015
$ 50.00
Remove
Add
JGP
check
07/25/2015
$ 50.00
Remove
® Add
JGP
check
09/12/2015
$ 50.00
❑ Remove
® Add
JGP
check
09/12/2015
$ 50.00
Remove
Add
JGP
check
09/04/2015
$ 50.00
Remove
Add
JGP
check
09/04/2015
$ 50.00
Remove
Add
$
Remove
Add
$
Remove
Add
REeE
$
Remove
❑ Add
1 VE UD
$
Remove
Add
$
Remove
Add
j, M' I Co. Mara of Dections
$
❑ Remove
❑ Add
$
❑ Remove
Add
$
Remove
❑ Add
$
❑ Remove
❑ Add
$
E] Remove
n Add
$
❑ Remove
Add
—
$
Remove
Add
$
❑ Remove
Add
$
❑ Remove
4. Total only this Page $ 400.00
5. Total of ALL CRO -1205 Pages $ 400.00
(This link omni be on Ree 5 of DeWedSaunwwy Page CRO -1100)
CRO -1205 NC State Board of Elections d.pri I_� ���'
Amendment
Contributions from Individuals Pg II of e ❑ Yea ® 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 1D Wember "
Committee To Elect Janice Propst
SJMR33
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Tine/Profession
d. Comments
Research
Janice G. Propst
531 Weddington Road
Matthews, NC 28104
c Employer's Name/Specific Field
Waterstone Defeasance
e. Election Sum to [late
$ 100.00
f. Prior
g. Account Code
Is. Form of Payment
I. In -Kind Description
j. Date (mm/dd/yyyy)
h. Amount
❑
JGP
Check
07/13/2015
$ 10().00
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & alp)
b. Job Title/Profession
d. Comments
Account Director
John Reid
1440 Willow Oaks Trail
Weddington, NC 28104
e. Employers Name/Specific Field
Level 3 Communications
e. Election Sum to Date
$ 100.00
f. Prior
g. Account Code
h. Form of Payment
1. In -Kind Description
J. ate (mm/dd/yyyy)
L Amount
❑
JGP
Check
08/27/2015
$ 100.00
d. Comments
3. Contributor Information ❑
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
Add ❑
b. Job Title/Profession
RECEIVEDc.
SET 2 8 2015
Whin Co. Board of Elections I
Employer's Name/Specific Field
1
e. Election Sum to Date
$
f. Prior
g. Account Code
Is. Form of Payment
I. In -Kind Description
J. ate (mm/dd/yyyy)
L Amount
❑
$
❑
$
4. Total only this Page s 200.00
5. Total of ALL CRO -1210 Pages s 190000
(This fine must be on line 6 ojDemlfedSamemy Page CRO -I100)
CRO -1110 N( Clate Board A Flections April 2007
Contributions from Individuals Pg 2 of 4 E] 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. IiD Number
Committtee to Elect Janice Propst
SJMR33
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing .Address & Phone
(include city, state, & rip)
b. Job Tide/Profession
d. Comments
Broker- Real Estate Owner
Jerry Fitzgerald
PO Box 3111
Matthews, NC 28106
c. Employers Name/Specific Field
Fitzcomm Real Estate,
e. Election Sum to Date
$ 500.00
L Prior
g. Meooat Code
It. Form of Payment
I. Ia-Kivd Description
J. Date (mrddd/yyyy)
k Amount
❑
JGP
Check
08/092015
$ 500.00
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
Owner
A Basil Polivka
3915 E Market Street E C E I V E D
Warren, OH 44484 SLP 2 8 2015
Uninn ro Board of Elections
e Employers Name/Specific Field
Polivka Inc.
I
e. Election Som to Date
I $ 500.00
L Prior
g. Account Code
It. Form of Payment
i. In -Mad Desaripaon
J. Date (mm/ddlyyyy)
b. Amount
❑
JGP
check
09/10/2015
$ 500.00
3. Contributor Information ❑ Add ❑RM
a. Full Name, Mailing Address & Phone
(include city, state. & zip)
b. Job Title(ProfeWou
d. Commend
Owner
Joseph Hudson
250 Rea Road
Waxhaw, NC
28173
c. Employers Name/Spedfic Field
RCS, Inc, Monroe, NC
Septic and Waste
e. Election Sum to Date
$ 100.00
L Prior
g. Account Code
Is. Form of Payment
i. Io -Mad Description
J. Date (mm/dd/yyyy)
h. Amount
❑
1GP
check
09/102015
$ 100.00
❑
$
❑
$
4. Total only this Page $ 1100.00
5. Total of ALL CRO -1210 Pages
$ 1900.00
(This line most be on tine 6 of DeWledSummmy Page CRO -1100)
CRO -1110 NCState Board of Elections April 2007
Amendment
Contributions from Individuals Pg -3 of 4 ❑ Yes ® No
Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used
1. Committee Fall Name (and Fund ifapplicable) 2. ID Number
Committee To Elect Janice Propst SJMR33
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, sate, & zip)
b. Job Titie/Proression
d. Comments
Sales
Joseph A DeSimone
1309 Willow Oaks Trail
Matthews, NC 28104
a Employer's Name/Specific Field
Courion , Manf. Elevator Doors
e. Election Sum to Date
$ 125.00
t Prior
g. Account Code
it. Form of Payment
i. to -Kind Description
J. Date (mm/dd/yyyy)
k Amount
❑
JGP
check
08/102015
$ 125.00
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, sate, & zip)
b. Job ThItYProtession
d. Comments
Retired / Homemaker
Mary Ann DeSimone
1309 Willow Oaks Trail RECEIVED
Matthews, NC 28104 t C
SEP[� 2 8 W 5
i Inion Co. Board of Election
e. Employer's NamelSpeciac Field
e. Election Sum to Date
$ 75.00
t Prior
g. Account Code
Is. Form of Payment
I. In -Kind Description
J. Date (mm/ddlyyyy)
h. Amount
❑
JGP
check
08/10/2015
$ 75.00
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, sate, & zip)
b. Job Titie/Profession
it. Comments
Retired, Air Force
Phillip G. Anderson
13624 Providence Road
Matthews, NC 28104
c. Employer's Name/Specific Field
s
e. Election Som to Date
$ 100.00
I. Prior
g. Account Code
h. Form of Payment
i. In -Kind Description
J. Date (mmldd/yyyy)
It. Amount
❑
JGP
check
08/09/2015
$ 100.00
❑
$
4. Total only this Page $ 300.00
5. Total of ALL CRO -1210 Pages
$ 1900.00
(This One avast be on line 5 of Detailed Su� Page CRO -1100)
CRO -1210 `.( lraa Hoard oil April 2007
%mendment
Contributions from Individuals Pg 4 of 4 ❑ tes ® 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
Committee to Elect Janice Propst
SJMR33
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
Retired food broker
Don Sinclair
1000 Heritage Acres, Matthews, NC 28104
c. Employer's Narn Specific Field
e. Election Sum to Date
$ 100.00
E Prior
g. Account Code
h. Form of Payment
i. In -Kind Description
j. Date (mso/dd/yyyy)
b. Amount
❑
JGP
check
07/28/2015
$ 100.00
❑
$
❑
$
3. Contributor Information onionXWORrff t'
Ove
a. Full Name. Mailing Address & Phone
(include city, state, & zip)
b. Job Titie/Profession
d. Comments
Retired - Banking
Barbara Sinclair
1000 Heritage Acres, Matthews, NC 28104
c. Employer's Name/Specific Field
e. Election Sum to Date
$ 100.00
E Prior
g. Account Code
h. Form of Payment
1. In -Kind Description
J. Date (mm/ddlyyyy)
h. Amount
❑
JGP
check
07/28/2015
$ 100.00
❑
$
❑
3. Contributor Information ❑ Add ❑ Remoly
$
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job TitiNProfession
d. Comments
Owner, Agritourism
Nancy D. Anderson
13624 Providence Road, Matthews, NC
28104
c. Employer's Name/Specific Field
Hunter Farms
L Election Sum to Date
$ 100.00
C Prior
g. Account Code
Is. Form of Payment
1.10-10nd Description
J. Date (mm/dd/yyyy)
K Amount
❑
JGP
Check
08/09/2015
$ 100.00
❑
$
❑
$
4. Total only this Page $ 300.00
5. Total of ALL CRO -1210 Pages
$ 1900.00
(This Rne must be on line 6 of Derailed Summary• Page CRO -1100)
CRO -1210 VC State Board of Elections April 2007
Amendment
Disbursements Pg 2 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 Fall Name and Fund if applicable) 2. ID Number
Committee To Elect Janice I SJMR33
3. Type of Disbursement lease use separate C 1 10 fenm for each Woe 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, & zip)
It. Coordinated Committee Name
d. Comments
USPS
South Providence Station
Charlotte, NC 28277
800 275-8777
a Level Registered (Specify)
0 Federal 0 County:
❑ state ® Municipality:
e. Election Sum to Date
$ 11.76
E Account Code
g. Form of Payment
Is. Purpose Code
i. Date (mm/dd/yyyy)
J. Amount
L Required Remarks
JGP
cc
1
08/26/2015
$11.76
4. Payee Information ❑ Add Remove
a. Full Name, Mailing Address & Phone
include city, state, & a
b. Coordinated Committee Name
it. Comments
Fairway Forms
7000 Stinson Hartis Road Rl E E C E I V E
Indian Trail, NC 28079
704 545 6655 10 2 8 206
e. Level Registered (Specify)
❑ Federal ❑ County:
❑ state ® Municipality:
e. Election Sum to Date
$ 133.44
E Account Code
g. Form of Payment
rob
i. Date (mm/dd/yyyy)
J. Amount
L Required Remarks
JGP
Check
B•
09/16/2015
$133.44
Palm Cards
$
4. Payee Information Add Remove
a. Full Name, Mailing Address & Phone
include city, state, & ri
b. Coordinated Committee Name
d. Comments
Wahnart
2101 Younts Road
Indian Trail, NC 28079
704 882-5566
c. Level Registered (specify)
❑ Federal ❑ County:
❑ state ® Municipality:
e. Election Sum to Date
$ 2.14
E Account Code
g. Form of Payment
L Purpose Code
i. Date (mm/ddlyyyy)
J. Amount
Ir. Required Remarks
JGP
CC
O'
09/18/2015
$2.14
Curling ribbon
5. Total only this Pae $ 147.34
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed Summary Page CRO -1 100 if Operating Expensev) $ 1432.63
(This line goes in line lab of Detailed Summary Page CRO -1100 if Comsib to Candidate.VPolilical Conon)
(This line goes in line l3c of Detailed Summary Page CRO.1100 if Coordinated PaM P-spenditures)
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)
Amendment
Disbursements Pg I of �✓ ❑ yea ® 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 Fuad ifapplicable) 2. I Number
Committee To Elect Janice Propst I SJMR33
3. Type of Disbursement Please use swarate CRO -1310 fomis for each type of Disbursement
® Operatine Expenses ❑ Contributions to Candidates/Political Clnnmiuccs ❑ Coordinated Party Expenditures
4. Payee Information Lj Add Remove
a. Full Name, Mailing Address & Phone
include city, state, & zi
b. Coordinated Committee Name
d. Comments
Sign Masters
314-B Depot Street
Monroe, NC 28112
704 225-0673
c. Level Registered (Specify)
❑ Federal ❑ county:
❑ State ® Municipality:
a Election Sum to Date
$ 352.20
E Account Code
g. Form of Payment
h. Purpose Code
L Date (mm/ddlyyyy)
J. Amount
Is. Required Remarks
JGP
check
B*
08/072015
$309.50
Signs
JGP
Check
B*
08/172015
$42.70
sign stands
4. Payee Information Add Remove
a. Full Name, Mailing Address & Phone
include city, state, & ri
b. Coordinated Committee Name
d. Comments
Sign Masters _ ^ I` , r D
314-B Depot Street �J C
Monroe, NC 28112 2015
704 225-0673
E1gCt10(5
c. Level Registered (Specify)
❑ Federal ❑ county:
❑ State ® Municipality:
e. Elation Som to Date
$ 1259.58
L Account Code
g. Form of Payment
h. Purpose Code
L Date (mmldi ftyyy)
j. Amount
K Required Remarks
JGP
check
B*
09/152015
$298.90
JGP
CC
B*
09/112015
$608.48
4.Payee lnformadoR Lj Add ❑ Remove
a. Full Name. )tailing Address & Phone
include city, state & a
b. Coordinated Committee Name
d. Comments
V istaprint
95 Hayden Avenue
Lexington,
MA
02421
866 614-8002
c. Level Registered (Specify)
❑ Federal ❑ county:
❑ State ® Municipality:
e. Elation Sum to Date
$ 25.71
E Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/ddlyyyy)
J. Amount
K Required Remarks
JGP
CC
B*
8/21/2015
$25.71
5. Total only this Pae
i $ 128529
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed Summa,:Page CRO -1100 If Operating Expenses)
(This line goes in line 136 of Detailed Summary Page CRO -1100 ifContrib to Candidates/Political co"
(This line goes in line 13c of Detailed Summary Page CRO -11001f Coordinated Party Expenditures)
$ 1432.63
7. Purpose Codes(List detailed ex nditure 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)