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Rape,Dennis_2021-Year-endAmendment Disclosure Report Cover ❑ Yea o No Use this form for general report and committee information, must be signed and submitted along with other detailed tbrnis. Do not u,c chi, form to u date information. 1. Committee a. Full Name u. IU ]umLcr E (ec_t e �) ti s iZ0 1 . Mailing Address (include City, State and Zip Code) d. tate Piled t4 -I-7 C"W,j LrQ e. Phone Number 98G-7al-�q/ N\oiJ"e tvC- 2, Report Year 3. Period Start Date (mmtddtyy) 4. Period End Date (mm/dd/yy) 5 Tr qg r_fgo,NamZ-V ,,D o I D i I 3t aoa Tern n5 6r tt �. Type o Rep rt (check only one type of report from'one category CandidateCampuign 13 Party Municipal State/County -- --- Referendum El PAC Referendum ❑Organizational —.._ ❑ Organizational — __- ❑ Organirational ❑ Independent Expenditure ❑ Joint Pundralser ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ Pre-primary ❑ Fust ❑ Final ❑ Pre-election ❑ Pre -runoff❑ ❑ Second Third ❑ Supplemental Final [3Annual (tfhpplita6le' Booster Fund Semi-annual ❑ Fourth ❑ Special ❑ Building Fund Mid Year Semi-annual Year End ❑ Mid Year 10. Special Report Name".:_ Q Other: ❑ Fnal ❑ Special 61� Year End ❑ Final 8. N' _ r of Fundraisers this Report 11. Account Information 11. Account Information . Financial Institution Full Name a. Financial Institution Full Name - C me b. Purpose C. Account Code Is Purpose c. Account Code ,�j ofeft, Or.J 4e -"ll -U d. Period Bekin Balance d. Period Begin Balance $ O.O6 1 $ CERTIFICATION Uni f I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 22D -22M of Chapter I GJ of the NC General Statutes and that no funds are commingled with prohibited or other non -disclosed funds. I further certify that thi, report is complete, true and correct and that I have been trained by the NC $,tate Board of EI tions. L{C//1 � TMmeSNrJ� S� D--, Printed Name of Signer Signature of Appointed Treasure I Lnc FOR OFFICE USE ONLY _ Date Received: mp oy Oti tven Vethod ❑ Normal Mail Date Postmarked: Employee: ❑Regis red Mail Delivered Date Scanned: Employee: eL/p I 1 d 1 ❑ Electronically Filed Date Data Entered: Employee: 1-3 Signer has not receivedmandatory trimmi 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-210OA-E) to make committee changes. CRO -1000 NC State Board of Elections August 2008 Detailed Summary Amendment ;es —� Use this form to summarize all disclosure reporting forms and to total monetary information 1. Committee Full Name (and Fund if applicable) - C_ l e c-- — 2N N t ice. 2. Type of RR _ — � _ 3. ID Number ZW r6 cel. / Start of Election Cycle: January 1, 20j Total this R=rting Period Total this Election C cle 4) Cash on Hand at Start RECEIPTS 5) Aggregated Contributions from Individuals 6) Contributions from Individuals 7) Contributions from Political Party Committees 8) Contributions from Other Political Committees 9) Loan Proceeds - - - 10) Refunds/Reimbursements to the Committee 11) Other Receipt Sources I la) Interest on Bank Accounts llb) Contributions from Not -For -Profit Organizations I lc) Outside Sources of Income ltd) Legal Expense Fund - Other Sources Ile) Exempt Purchase Price Sales (CRO -1205) (CRO -1210) (CRO -1220) (CRO -1230) (CRO -1410) (CRO -1240) (CRO -1250) (CRO -1250) (CRO -1250) (CRO -1270) (CRO -1265) $ $ $Lp$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ [1 $ 12)TOTAL RECEIPTS (Add I i nes 5. 6, 7, 8, 9, 10,11 a, I l b, l l c, EXPENDITURES 13) Disbursements 13a) Operating Expenditures 13b) Contributions to Candidates/Political Committees 13c) Coordinated Party Expenditures 14) Aggregated Non -Media Expenditures l l d and l l e) (CRO -1310) (CRO -1310) (CRO -1310) (CRO -1315) $d o $ $ $ $ eo ,�.$ $ $ $ $ 15) Loan Repayments 16) Refunds/Reimbursements from the Committee 17) In -Kind Contributions (CRO -1420) (CRO -1320) (CRO -7510) $ $ $ $ $ 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ $ 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18 $ 74, 0 $ , Q ADDITIONAL INFORMATION 0) Non -Monetary Gifts Given to Other Committees 1) Outstanding Loans (incl. ones from other campaigns) 2) Debts and Obligations owed by the Committee 23) Debts and Obligations owed to the Committee 24) Account Transfers Within the Committee (CRO -1330) (CRO -1430) (CRO -1610) (CRO -1620) (CRO -1720) $ $ $ $ $ - 5) Administrative Support (CRO -1710) $ RECEIV$ 26) Forgiven Loans (CRO -1440) $ $ 7) 48 -Hour Notice Reports Sum (CRO -2220) $ $ 128) Contributions to be Refunded (CRO -121S) $ $ CRO -1100 NC State Board of Elections August 2008 )0 nd Contributions from Individuals Pg _ of _ ❑eves —at ❑ No Use this form to report individual contributions over $50 or contributions under S50 if form CRO 1205 is not used 1._Committe Full Name (and Fund if applicable) 2. ID Number 3. Contributor Information ❑ Add ❑ Remove a. Full Name. Mailing Address & Phone (include city, state, & zip) !��y, L. p 1 ,11 lI 41sdwn'o16154 Loo rPe/ 1 ,i, ��/'�jtlJp�J/ b. Job Title/Profession -.--- n - leo {k- (,Oh'1m1�i1 d. Comment} V' Employer's Nu e/Specifc Field I "' Election Sum to Dale f.Prior g. Account Code h. Form of Payment i. In -Kind Description I. Date (mm/dd/yyyy) it. Amount ❑ $ 06 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Titie/PrufesAmt - - d. Comments c. Employer's Name/Specific Field e. Election Sum to Date f. Prior El g. Account Code h. Form of Payment i. In -Kind Description J. Date (mm/dd/yyyy) it. Amount ❑ $ ❑ S 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, stale, & zip) h. Job TillefProfession d. Comments - - -- --- c. Employer's Nume/Specilic Fleld e. Elecllon Sum to Date $ I'. Prior ❑ g. Account Code h. Form of Payment i. In -Kind Description J. Dale (tmn/dd/yyyy) It. Amount $ ❑ $ ❑ $ 4. Total only this Page $ 5. Total of ALL CRO -1210 Pages (This line muss be on line 6 of Detailed Summnrr Page CRO -1100) ! W CRO -1210 NC State Board of Elections April 2007 Disbursements Pg _ of ❑ Yes ❑ No Amendment Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political committees and coordinated oariv exuenditures Lommitteeee Ful Name (and Fund if applicable) " om 2. ID" Number 3. Type of Disbursement Please usk separate CRO -1310 fonns for each type of Disbursement. r.. ❑ O teraul Es rose' ❑ Co11119butwil, to ❑ Os"'finatcd Pan Lr re ' imm. 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone b. Coordinated Committee Name d. Comments (include city, stale, & zip) _ {�Crl ✓l�rJ /A�1�i /'(,,� C►� II.� �, //,It7_/MI(' l� '✓' / ^�//� c. Level Registered(S lfy) _. ❑ Fed,ml IPruCounty: ❑ Slate Municipality: e. Electtou Sum to Date $ Z r. Account Code g. Form of Payment h. Purpose Code 1. Date (rmn/dd/yyyy) / 3t J. Amount $ it. lRe .rF ire em�k 1 Is 1 4. Payee Information ❑ ,Add ❑ Remote a. Full Name, Mailing Address & Phone b. Gmrdinated Committee Name d. Comments (include city, state, & zip) c. Level Registered (Specify) Federal 0 County: ❑ State ❑ Municipality: e. Election Sum to Date f. Account Code g. Form of Payment h. Purpose Code t. Date I mnddd/yyyy) j. Amount it. Required Remarks $ 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone h. Cuordimded Committee Name It. (''morn' (include city, stale, & zip) c. Level Registered (Specify) ❑ I'deral County: ❑ State ❑ Municipality: e. Election Sum to Date $ L Account Code g. Form of Payment It. Purpose Code 1. Date (mmldd/yyyy) J. Amount k. Required Remarks $ 5. Total only this Page $ 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (Thu line goes in line 136 of Detailed Summary Page CRO -1100 if Contrib to Candidoses/Political Comm) $ �7 C Q (This line goes in line Be o Detailed Summa Page CRO -1100 i rt Er endil Coordinated Paures) of J 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 *4o des r uire detailed explanation in required remarks field (k) CRO -1310 NC Slate Board of Elreiiun. !t;" 1,1 ei 7' "