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Smith, Brandi-2021-35-Day-ReportAmendmient Disclosure Report Cover [0.y P [0.yes s es Q No __ Use this form for general report and committee information, must be signed and submitted along with other detailed forms. Do not use thi, form to update information. I. ommittee Information a. Full Name c ID Number rk . Mailing Address (include City, State and Zip Codd-, Filcd qd./vD�'ate 1 1 e. Phone Number 3 _ �cl 2. Report Year 3. Period Start Date (mmtddtyy) Period End Date (mmtddtpy) 5. Treasure Full Name ��I �4. �� �1 9 a� ao�1 , � o� �� fv�I 6, pe of Committee (Check One) 9. Type of Report (check only one type of report front one category) EDC�'andidate Campaign ❑ Party Municipal State/County 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 -runoff ❑ Second ❑ Third ❑ Supplemental Final ❑ Annual 7. Type of Fund (lPopplicohle, check one) ❑ Boosicr Fund Semi-annual ❑ Fourth ❑ Special ❑ Buildip, Fund ❑ Mid Year Semi-annual ❑ Year End ❑ Mid Year 10. Special Report Name ❑ Oihcr: ❑ Final ❑ Special ❑ Year End ❑ Final 8. Number of Fun"a* ers this Report (j ❑ Special 11, Account Information 11. Account Information a. Financial Institution Fu Name notion Full Name �_ Fimmcl'il 1`a'tIUN tc"l COUNTY . Purpose c. Account Code b. Purpase "OPAIUN FINANULc. Account Code � I1 QL" 5— SEP 2 7 2021 r*c_ d. Period Begin Balance d. Period Begin Balance ,.1 r� �J V $ 00 RECEIVED $ CERTIFICATION 1 certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B & 2213-22M of Chapter 163 of the NC General Statutes and that no funds are commingled with prohibited or QLher non -disclosed funds. 1 further certify that this report is com//p��le�t�e, true and and that I rris� 'ned by the a d mFEieetiens. _ �/correct /} 11 Printed Name of Si ner Sigilliatre of AuuguittTTr4suAr Date FOR OFFICE USE ONLY Date Received: a Employee: Delivery Method ❑ Normal Mail Date Postmarked: Employee: Registered Mail Hand Delivered Date Scanned: Employee: Electronically Filed er has not Date Data Entered: Employee: maandatory =received trainin 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 -2100A -E) to make committee changes. CRO -1000 NC State Board of Elections August 2008 Detailed Summar Amendment Y ❑Yes. _ o_No Use this form to summarize all disclosure renortine forms and to total monetary information 1 Committee Full Name (and Fund if applicable) — - - -- - J t 2. Type of Report 3. ID Number I✓ Start of Election Cycle: January 1,Total this jRevorting P riod Total this Election Cycle 4) Cash on Hand at Start I $ $ 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 la) Interest on Bank Accounts 11b) Contributions from Not -For -Profit Organizations Ile) 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) $ $ $ ala $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9,10,1 la l l b, l 1c.1 Id and Ile) $ I a a 1p $ 1-10 ', EXPENDITURES 13) Disbursements 13a) Operating Expenditures 13b) Contributions to Candidates/Political Committees 13c) Coordinated Party Expenditures 14) Aggregated Non -Media Expenditures 15) Loan Repayments 16) Refunds/Reimbursements from the Committee 17) In -Kind Contributions (CRO -1310 (CRO -13W) (CRO.1310) (CRO -131b (CRO -142) (CRO -1320) (CRO -1510) rSUN COUNTY $ - $ S£P $ $ $ $ $ $ i . 3 4 $ 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ if $ '3 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line IS $ . 0 $ dD ADDITIONAL INFORMATION 20) Non -Monetary Gifts Given to Other Committees 1) Outstanding Loans (incl. ones from other campaigns) 2) Debts and Obligations owed by the Committee 3) Debts and Obligations owed to the Committee 4) Account Transfers Within the Committee 5) Administrative Support ) Forgiven Loans 7) 48 -Hour Notice Reports Sum Contributions to be Refunded (CRO -1330) (CRO -1430) (CRO -1610) (CRO -1620) (CRO -1720) (CRO -1710) (CRO -1440) (CRO -2220) (CRO -1215) $ $ $ $ $ t $ $ $ $ $ $ $ $ CRO -1100 NC State Board of Elections August 2008 Amendment _..... _. In -Kind Contributions Pg _ of _ ❑ Yes ❑ 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 Name (and Fund if applicable) _ 2. ID Number IIff v I tl y- llt [� 3. Contributor Information U ❑ Add ❑ Remov a. Pull Name, \lailing Address & Phone b. Type of Contribute c. Comments (include city, state, & zip) Individual �Ly`�rl ( ❑ Candidate W �� lQ. � • [3 Party ❑PAC d. Election Sum to Date �jn� t�J� O rU� [3 Referendum ❑ Other Receipt Source $ D . 2 1Y _ . Descripfioa L Date (mailddlyyyy) g. Fair Market Amount t1(�' $ t' $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone b. Type of Contributor c. Comments (include city, state, & zip) Individual ❑ Candidate ❑ Pay ❑ PAC ❑ Referendum d. Election Sum to Date ❑ Other Receipt Source - tJTY $ e. Description -aMRA(Gt�LFINA _ r. Date (mm/atUyyyy) g. Fav Market Amount 2021 sip $ S 3. Contributor Information ❑ Add ❑ Remove a. 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 $ e. Description E Date (mm/ddlyyyy) g. Fair Market Amount $ $ $ 4. Total only this Page 5. Total of ALL CRO -1510 Pages $ 3 (This line mist be on line 17 of Detailed Summary Page CRO -1190) CRO -15/0 NC Sane baud of h:lecGom December 2007 Amendment Contributions from Individuals Pg or _ ❑ Yes ❑ Nn Use this form to report individual contributions over S50 or contribul ion; under S50 if form CRO 1205 is 1101 used L-Cgmrtdt�-teeFall Name {and Fund if applicable) i 2. ID Number til 3. Contributor Information ❑ Add ❑ Remo a. Full Name, Mailing Address & Phone (include city, state, & zip) ivwyu� 00 b. Job Title/ProfeAsKn d. Comments c. Employer's Name/Specinc Field YfTI `Q o l3iv`^ e. Election Sam to Date $1, 3 qct. 3(00 . Prior g. Account Code h. Form of Payment A 1. to -Kind Description J. Date (mo /ddtyyyy) k Amount o6j 3L ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) VPJION GC (P�ANGE b. Job Title/Profession d. Comments c. Employer's Name/Speelnc Field e. Election Sam to Date . Prior ❑ g. Account Code h.rt(; Fo I. In j nd Description J. Date (mmlddlyyyy) Amount We Deni ° G $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments c. Employer's Name/Specific Field e. Election Sum to Date P. Prior ❑ g. Account Code h. Form of Payment I. In -Kind Description J. Date (mmIdd/yyyy) k Amount $ ❑ $ ❑ $ 4. Total only this Page 5. Total of ALL CRO -1210 Pages (This line must be on line 6 of Detnited Summar• Page CRO -1100) $ _ 3 CRO -1210 NC Shue Board 0r kle,tions April 2007