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"