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Record,James_2021-FinalAmendment Disclosure Report Cover ❑ Yea ® 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 Committee to Elect James Record L4 J M ST b. Mailing Address (iudade City, State and Zip Code) d. Date Filed 7309 Conifer Circle, Indian Trail, NC 28079 07/02/2021 e. Phone Number 980-298-8353 2. Report Year 3. Period Start Date (mm/dd/yy) 4. Period End Date mm/d 5. Treasurer Full Name 2021 01/01/2021 12/31/2021 James Record 6 of Committee Check One 9. Type of Report check only one type of r ort ora one category) ® Candidate Campaign ❑ Party Municipal State/County Referendum ❑ Organizational ❑ Organizational ❑ Organizational ❑ PAC ❑ Referendum Independent ❑ Joint Fundraiser ❑ Expenditure ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fond ❑ Pre-primary ❑ Preclection ❑ First ❑ Second ❑ Final ❑ Supplemental Final 7. Type of Fund (ifappfrcahle, check ora!) ❑ "Booster Fund" ❑ Building Fund ❑ Pre -runoff ❑ Third ❑ Annual Semi-annual ❑ Fourth ❑ Special ❑ Mid Yew Semi-annual ❑ Other ❑ Year End ❑ Mid Year 10. Special Report Name ® Final ❑ Special ❑ Yew End ❑ Final ❑ Special 8 Number of Fundraisers this Report 0 11. Account Information 11. Account Information a. Financial Institution Full Name a. Financial Institution Full Name b. Purpose c. Account Code b. Pe N'ON c Account Code CAM PAI C 2022 O 6 d. Period Regio Balance d. Period Begin Balance JAN $ s RECEIVED 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 NC Sta oard f E ctions. r James Record L/ 1_6 — ZZ Printed Name of Signer gnature of Appointed Treasurer Date - ORDFFICE USE ONLY ^ .� Employee: Date Received: Q� d2T Emp ee: Delivery Method ❑ Normal Mail Date Postmarked: Employee: / � � Employee: Date Scanned: ' I Registered Mail Hand Delivered Electronically Filed ❑ Signer has not received I/_ 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 Or anization CRO -2100A -E to make committee changes. CRO -1000 NC State Board of Elections August 2008 Amendment Detailed Summary ❑ Yes ❑ No Use this form to summarize all disclosure reDorfing forms and to total monetary information. 1. Committee Fall Name and Fund if applicable) 2. Type of Report 3. ID Number Committee to Elect James Record Final J M S r Start of Election Cycle: January 1, 2021 Total this Reporting Period Total this Election Cycle 4) Cash on Hand at Start S 0 $ 0 5) Aggregated Contributions from Individuals (CRO -1205) 6) Contributions from Individuals (CR04210) 7) Contributions from Political Party Committees (CRO -1220) 8) Contributions from Other Political Committees (CRO -1230) 4) Loan Proceeds (CRO -1410) 10) Refunds/Reimbursements To the Committee (CRO -1240) 11) Other Receipt Sources Ila) Interest on Bank Accounts (CRO -1250) lib) Contributions from Not -for -Profit Organizations (CRO -1250) Ile) Outside Sources of Income (CRO -1250) 11d) Legal Expense Fund — Other Sources (CRO -1270) 11 e) Exempt Purchase Price Sales (CRO -1265) $ 0 $ 0 $ 1244.35 $ 1244.35 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 12) TOTAL RECEIPTS (Add loves 5.6.7,8.9,10,Ila, llb.11c.11dadfie) $ 1244.35 $ 1244.35 13) 14) 15) 16) 17) 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 -1510) $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 S 1244.35 S 1244.35 18) TOTAL EXPENDITURES (Add Maes Ba, 13b,13c, 14. 15. 16 and 17) $ 1244.35 $ 1244.35 19) Cash on Hand at End (,1ddlassl and 12logether,then sabtractline18) ADDITIONAL INFOI&MICA $ $ S $ $ $ 0 0 0 0 0 0 $ 0.00 20) 21) 22) 23) 25) 26) 27) 28) 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 CGUNTM(CRO-1620) UNION24) Account Transfers Within theCommitMpAIGN FINANamo) Administrative Support SAN p 6 2p22(CRO-1710) Forgiven LoansCE�` IrK0?q-u40) 48 -Hour Notice Reports Sum RE (CRO -2220) Contributions to be Refunded (CRO -1215) $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 CRO -1100 NC State Board of Elections August 2008 Amendment Contributions from Individuals Pg l of I ❑ ves ® 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 James Record `4 ,..) 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & rip) b. Job Tine/Profession d. Comments Finance James Record 7309 Conifer Circle INdian Trail, NC 28079 a Employer's Nome/Speelfie Field MUFG e. Election Sam to Date $ 611.54 6 Prior g. Aeeount Code h. Form of Payment i. In -Kind Description j. Date (mm/ddlyyyy) K Amount ❑ Mastercard Paper/ink Oct 2021 $ 79.81 ❑ Mastercard T -Shirts Sept 2021 $ 106.75 ❑ Mastercard Yard Signs Aug 2021 $ 424.98 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & rip) b. Job Title/Profession d. Comments Finance James Record 7309 Conifer Circle Indian Trail, NC 28079 a Employer's Name/Specific Field MUFG e. Election Sum to Date $ 632.81 E Prior g. Account Code It. Form of Payment i. Io -Kind Description j. Date (mm/dd/yyyy) h. Amount ❑ Mastercard Postcards Oct 2021 $ 620.00 ❑ Mastercard Misc Oct 2021 $ 12.81 ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments UMOf\ MANGE CAMPAIGN F JAN 0 b rn ECENC-D c. Employer's NameApecific Field c. Election spm to Date $ f. Prior g. Account Code h. Form of Payment i. In -Kind Description I. Date (mm/dd/yyyy) h. Amount ❑ $ ❑ $ 4. Total only this Page S 1244.35 5. Total of ALL CRO -1210 Pages $ 1244.35 (This fine maw be on fine 6 of Detailed Sommmry Page CRD -1100) CRO -1210 NC State Board of Elections April 2007 Amendment In -Kind Contributions Pg 1 of 1 ❑ ves ® No Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund. use UKU-IL 1 J II In-Kma contributions were or WI [I De retunaea wimm / as s. 1. Committee Full Name and Fond ifapplicable) 2. IID Number Committee to Elect James Record Ll 'T' M a. Full Name, Mailing Address & Phone (include city, state, & rip) It. Type of Contributor c. Comments ❑ Individual ® Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source ❑ Candidate James Record 7309 Conifer Circle Indian Trail, NC 28079 d. Elections Sam to Date $ 611.54 e. Description E Date (mm/ddlyyyy) g. Fair Market Amount Paper/Ink Oct 2021 $ 79.81 T -Shirts Sept 2021 $ 106.75 Yard Signs Aug 2021 $ 424.98 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state,&zip) b. Type or Contributor c. Comments ❑ Individual ® Candidate ❑ Part ❑ PAC ❑ Referendum ❑ Other Receipt Source James Record 7309 Conifer Circle Indian Trail, NC 28079 it. Election Sum to Date $ 632.81 C. Description E Date (mm/ddlyyyy) g. Fair Market Amount Postcards Misc Oct 2021 $ 620.00 Oct 2021 $ 12.81 3. Contributor Information Ll Add a. Full Name, %tailing Address & Phone (include city, state, & rip) '1PN�b 1611 It. Type of Contributor c. Comments ❑ Individual ❑ Candidate ❑ Ply ❑ PAC ❑ Referendum it. Election Sum to Date ❑ Other Receipt Source $ e. Description `lv E Date (mm/dd/yyyy) g. Fair Market Amount $ 4. Total only this Pae $ 1244.35 5. Total of ALL CRO -1510 Pages (This /ine hart 3e on fine l7 ojDemUed Summary Page CRO -1100) $ 1244.35 "RO-1510 NC State Board of Elections December 200"