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Richards,Mark_2021-Year-endmendment Disclosure Report Cover A0 Yes t3Nn 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 . Full Name c. c.ID Number -n+-c lOM1FxITiit £�£C ikI:QIL QtGLFgY2as . Mailing Address (include City, State sad Zip Code) it. Date Filed e. Phone Number 2. Report Year 3. Period Start Date (mmlddiyy) 4. Period End Date (mdchu ) S. Treasurer Full Name Z-OZI /V-ra-21 /Z-31- Zt IYlli:i2ie� 14 Qtr-w"D's 6. Type of Committee (Check One) 9. Type of Report (check only one type of report from one category) - ® Candidate Campaign ❑ Party Municipal Statelcounty Referendum ❑ PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational ❑ Independent Expenditure ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ Pre-primary ❑ First ❑ Final ® Pre-election ❑ Pre-mnoff ❑ Second ❑ Third ❑ Supplemental Final ❑ Annual . Type of Fund (f applicable, check one) ❑ Booster Fund Semi-annual ❑ Fourth ❑ Special ❑ Building Fund ❑ Mid Year Semi -arcual ® Year End ❑ Mid Year 10. Special Report Name ❑ Other: ❑ Final ❑ special ❑ Year End ❑ Final 8. Number of Fundraisers this Report ❑ special 11. Account Information 11. Account Information . Financial Institution Full Name a. Financial Institution Full Name . Purpose c. Account Code b. Purpose c, Account Code d. Period Begin Balance it. Period Begin Balance $ $ CERTIFICATION I 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 State Board offllictions. MYi-21e l4 2tetxe'��Ros ��� � 1-z8-zZ Printed Name of Signer Signature of Appoimed Treastm7 Dais FOR OFFICE USE ONLY fl��t� 'ver Method Date Received: Zb Z2 EmplP!"" - _ Normal Mail �[03 Date Postmarked: Employee: Registered Mail Id Delivered Date Scanned: ;LU I � Employee: /❑ Electronically Filed 4 ❑ Signer has not received Date Data Entered: Employee: -mandatory training Please Note: Thisform cannot be used to amend committee information such as the cotmniucle address, treasurer. assistant treasurer, custodian of books information, or account information. You must amend the Statement of Organization (CRO -2100A -E) to make commi 6. CRO -1000 NC State Board of Elections Au,..: RECEIVL-L-, Detailed Summa Ame �' ❑ yeses ®No Use this form to summarize all disclosure renorting fortes and to total monetary information 1. Committee Full Name (and Fund if applicable) Mpzr. T�♦i Caa wK t rr LC jw [stet KLM Cos 2. Type of Report Pat: 3. ID Number Start of Election Cycle: January 1, Total this Period Total thisFReporting Election CN cle 4) Cash on Hand at Start $ ET $ RECEIPTS 5) Aggregated Contributions from Individuals 6) Contributions from Individuals 7) Contributions from Political Party Committees (CRO -1205) (CRO -1210) (CRO -1220) $ $ $ Z4, (o p $ $ $ 8) Contributions from Other Political Committees 9) Loan Proceeds 0) Refunds/Reimbursements to the Committee 1) Other Receipt Sources lla) Interest on Bank Accounts (CRO -1230) (CRO -1410) (CRO -1240) (CRO -11250) $ $ $ $ $ $ $ $ 11b) Contributions from Not -For -Profit Organizations (CRO.1250) $ $ llc) Outside Sources of Income (CRO -1250) $ $ 11d) Legal Expense Fund - Other Sources (CRO -1270) $ $ Ile) Exempt Purchase Price Sales (CRO -1265) $ $ 2) TOTAL RECEIPTS (Add lines 5,6,7, 8,9,10,11 a. I I b,l I c, I Id and I le) $ Zt;, GO $ ll (aNt23 EXPENDITURES 3) Disbursements 13a) Operating Expenditures (CRO -1310) $ $ 13b) Contributions to Candidates/Political Committees (CRO -1310) $ $ 13c) Coordinated Party Expenditures (CRO -1310) $ $ 4) Aggregated Non -Media Expenditures (CRO -1315) $ $ 5) Loan Repayments (CRO -1420) $ $ 16) Refunds/Reimbursements from the Committee (CRO -1320) $ $ ) In -Kind Contributions (CRO -1510) $ Z(.,&c $ t G N t 23 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ Z& , pO $ y t Z3 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line I8 $ 'ET $ DITIONAL INFORMATION 120) Non -Monetary Gifts Given to Other Committees 1) Outstanding Loans (Ind. ones from other campaigns) (CR&1330) (CRO -1430) $ $ Debts and Obligations owed by the Committee Debts and Obligations owed to the Committee Account Transfers Within the Committee 5) Administrative Support Forgiven Loans n 48 -Hour Notice Reports Sam Contributions to be Refunded (CRO -1610) (cte061626) (CRO -1720) (CRO -1710) (CR04440) (CRO -2220) (CRO -1215) $ $ $ ima" $ 5 $ j $ y $ CRO -1100 NC State Board of Elections Auru,1 '_urs Amendmml Contributions from Individuals Pit t of 1 ❑ Yea ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Fan Name (siall _VWW If appReable)__ TI+£ OommiTrtc -M Ctccr MAalc iZlcup2os 2. ID Number 3. Contributor Information 0 Add 0 Remove . Full Name, Mailing Address & Phone (include city, state, & zip) 02-W-P—I CFI 4 Q- DS (O Z% ck F7 C 1A l� D I SIJ T1244 -it. tiJC. deaf b. Job Title/Profession d. Comments c Employer's NaredSpecitic Field e. Election Sum to Date $ ZG,(op .Prior & Accomt Code h. Form efPsymem 1. In -Kind Description J. tete (mm/ddlyyyy) t Amomt ❑ Cl ,� 51,KV. s r-oa. 5oNs /o/uA $ Z.L.Go ❑ $ 3. Contributor Info=tion Add In Remove . Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession it. Comments Q Employer's Name/Specific Field e. Election S® to Date f.Prior ❑ g. Account Code h. Form of Payment i. In -Kind Description J. Date (mm/ddlyyyy) h. Amount $ ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ ve a. Full Name, Mailing Address & Phone (include city, slate, & zip) b. Job TitictProfession d. Comments c. Employer's Name/Specific Field e. Election Sam to Date r.Prior ❑ 6. Accomi Code h. Folm of Payment t. Io-Kimi Description j. Date (mmldd/yyyy) t Ansa®t $ ❑ $ ❑ $ 4. Total only this Page $ ZG • &0 5. Total of ALL CRO -1210 Pages A fv i' "%027 (This line must be online 6 of Detailed. Summary Page CRO -1100) $ --7 2L t (a O CRO -1210 NC State Board of Elections April 2(X)7 Amendment In -Kind Contributions Pg _L of ! ❑ ,res C1 No Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund. Use CRO -1215 if In -Kind Contributions were or will be refunded within 7 days. 1. Committee Full. (and Fund if applicable) 2. ID Number Tlks Covv%v% i ft"££. TU ELECT 1YLi2C. aICl41l4Qp5 3. Contributor Information Add Remove . Full Name, Mailing Address S. Phone (include City, slate, & zip) b. Type of Contributor ❑ Individual c. Comments n 10001-A IGlG6MQA5 ®Candidate ❑ Part G lzq CarFr X12 ❑ PAC ❑ Refemndum d. Election Sum to Date -TA) D t ri,.a -r at41L/ Ak a$ Q7q ❑ Other Receipt Source $ Z C O •. Description L Date (mm/ddlyyyy) S. Fair Market Amount 5Tr*V 5 Fol $ Zoo, Dov 3. Contributor Information ❑ Add Remove . Full Name, Mailing Address & Phone b. Type of Contributor c. Comments (include city, state, & zip) ❑ Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum d. Election Sum to Date ❑ Other Receipt Source $ . Description 4 Date (mmtdd/yyyy) g. Fak Market Amount $ $ $ 3. Contributor Information ❑ Add ❑ Remove • . Full Now, Mailing Address & Phone (include city, state, & zip) b. Type of Contributor ❑ Individual c. Comments ❑ Candidata ❑ Party ❑ PAC ❑ Referendum d. Election Sum to Date ❑ Other Receipt Source $ . Description L Date Imm/dd/yyyy) g• Fair Market Amount $ $ $ 4. Total only this Page $ ZG . (o 0 5. Total of ALL CRO -1510 Pages jAN c 7021 (This line wast be on line 17 of Derailed Sawrnary Page CRO -1100) $ CRO -1510 NC State Board of Elections December 2007