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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)