Smith,Brandi_2021-PreElectionReportndm
DISCIOSure Report Cover `AOmeYes ❑ No
Use this form for Lencial report and committee information, must be signed and submitted along with other detailed forms.
Do Hot u.c thi, 101111 Io updulr in!brin.Hiou_
L Committee Information
a. full Name
c. ID.Number
i�rCULZL'�
It. Mailing Address (include City, State and Zip Code)
it. Date Flied
_
rj�/00 �C-M -
e. Ph rte Num er
ffC ;�i-73
1j6Wh67_Z0
2, Report Year
3.'Period Start Date (mm/dd/yy) 4. Perjoij End
Pate (mm/dd/yy)
5. Treasure ull Name
�0 al
L i v
6:aype of Committee juG`heck Ong
4. Type of Report
Municipal
(check
only one type of report
State/County
front one category)
Referendum
�'Eandidate Campaign ❑ Party
❑ PAC ❑ Referendum❑
izational
❑ Organizational
[3 Organizational
[3O Independent Expenditure ❑ Joint Fundraiser
-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
Ob -primary
Pre-election
❑ First
❑ Final
❑ Pre-mnoff
❑ Second
❑ Third
❑ Supplemental Final
❑ Annual
7. Type of Fund (if njip(lrnhfe; '
❑ Booster Fund
Semi-annual
❑ Fourth
❑ Special
❑ Building Fund
❑ Mid Year
Semi-annual
❑ Year End
❑ Mid Year
10. Special Report Natkte,',
❑ Otho.
❑ Final
❑ special
❑ Year End
❑ Final
8: Namber of Fundraisers this Report
❑ Special
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
It. Purpose
c. Account Code
h. Purpyg PAIGN FINANI
H5
c. Account Code
00 �T
0C I 7 2 5 2021
d. Period Begin Balance
it. Period Begin Balance
�CCY
$ 0D , IL
EIVEL)
$
CERTIFICATION
I certify that the Committee or Fund is in compliance with all applicable
provisions of Article 22A, 22B & 22D -22M of Chapter 167
of the NC General Statutes and that no funds are commingled witl
er non-clisclosed limits. father certify that this
report is complete, true and correct and that 1 have been trained It
C State Board of Elections.
r
0
Printed Name of Signer Signat
e p d Treas r Date
FOR OFFICE USE ONLY
Date Received: 1 Employee:
Delivery Method
❑ Normal Mail
❑ Registered Mail
Date Postmarked: Employee:
Hand Delivered
Date Scanned: a Employee:
Electronically Filed
Date Data Entered: Employee:
I-] Signer has not received
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 Organization (CRO -2100A -E) to make committee changes.
CRO -1000 NC State Board of Elections August 2008
Detailed Summar Amendment
y ❑ Yes ❑ No
Use this form to summarize all disclosure reoortine forms and to total monetary information
1. Committee Full Name (and Fund jftapplicable) _
6Y (t
_Type
eport-
_
3. ID Number
t015
Start of Election Cycle: January 1,
otal this
Period
Total thisReg2rfig
Election Cycle
4) Cash on Hand at Start
I$
O
$
RECEIPTS
5) Aggregated Contributions from Individuals
6) Contributions from Individuals
7) Contributions from Political Party Committees
8) Contributions from Other Political Committees
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
$
$
$ O
$
$
$
$
9) Loan Proceeds _
(CRO -1410)
$
$
10) Refunds/Reimbursements to the Committee
Il) Other Receipt Sources
lla) Interest on Bank Accounts
llb) Contributions from Not -For -Profit Organizations
lle) Outside Sources of Income
11d) Legal Expense Fund - Other Sources
lle) Exempt Purchase Price Sales
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
$
$
$
$
$
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10,11 a, I I b, I I c, I I d and I I e)
$
D.(n
$tpq2i.hs
EXPENDITURES
13) Disbursements
13a) Operating Expenditures
13b) Contributions to Candidates/Political Committees
(CRO -1310)
(CRO -1310)
$
$
$
$
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 -1315)
(CRO -1420)
(CRO -1320)
(CRO -1510)
$
$
$
$
$
$
$
$
$ oa i�
$
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$
V7i
$
G -
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$
M 01)
$
00
ADDITIONAL INFORMATION
0) Non -Monetary Gifts Given to Other Committees (CRO -1330)
1) Outstanding Loans (incl. ones from other campaigns) (CRO -1430)
22) Debts and Obligations owed by the Committee (CRO -1610)
3) Debts and Obligations owed to the Committee Ot((t620)
4) Account Transfers Within the CommitteCAM�N F1 720)FI 720)
$
$
$
$
$
5) Administrative Support 2 5 001710)
$
$
6) Forgiven Leans
C
$
$
7) 48 -Hour Notice Reports Sum
8) Contributions to be Refunded
0)
(CRO -1215)
$
$
$
$
CRO -1100 NC State Board of Elections August 2008
Amendment
Contributions from Individuals Pg of ❑ Yes ❑ No
Use this form to report individual contributions over $50 or contributions under S50 if form CRO 1205 is not used
1. Committee Full Name (and Fund if applicable) _
2. ID Number
3. Contributor Information A
❑ Remoye
a. Full Name, Mailing Address & Phone
((in�cludde' city, state, & zip)
b. Job Titie/Prof n
d. Comments
/ d'r(��y� /' ,,[(, ,�/O ' , ,� n ,,
T W M C.Y�-��"�C Mme" (Z"
'7 3
c. Employer's Name/Specific Field
n
��C ,
e. Election Sum to Date
f. Prior
g. Account Code
It. Form of Payment
i. In -Kind Description
j. Date (mmtdd/yyyy)
k Amount
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. full Name. Mailing Address & Phone
(include city, state, & zip)
b. Job TitletProfession
d. Comments
c. Employer's Name/Specific Field
e. Election Stun to Date
$
f.Prior
g. Accounl Code
h. Form of Payment
i. In -Kind Description
J. Date (mmtddtyyyy)
k Amount
❑
$
❑
$
3. Contributor Information ❑ Add ` ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)_
Id COUNTY
At RIN E
b. Job Title/Profession
d. Comments
--
c. Employer's Name/Specific Field
e. Election Sum to Date
$
f.Prior
g. Account Code
h. Form of Payment
I. In -Kind Description
J. Date (mmldd/yyyy)
k Amount
❑
RECEIVED
$
❑
$
4. Total only this Page Is
ito
5. Total of ALL CRO -1210 Pages
(This line must be on line 6 of Detailed Summary Page CRO -1100)
$
CRO -1210 NC.St.r_ hoxd of[ lcciiom April 2007
Amendment
In -Kind Contributions Pg _ of _ [3Y es ❑ 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 of will be refunded within 7 days_
1. Committee Full Name (and Fund if applicable)
2. ED Number
3. Contributor Information A d ❑ Remove
. Full Name, Mailing Address & Phone
(include city, slate, & zip)
&,(,A e4' /y�, y{/�/ 7�- ,Q���� }'� //
70w / L ly'4 _ - ' / ""' � '
` �0/r/ 2
(M.til LL l
b. 'I _N pe of CoutribatW
c. Comments
-- _--
OA1.1mclual ---
❑ Candidate
❑ Party
PAC
Ell Referendum
❑Other Receipt Source
d. Election Sum to Dale
$ Ll D—
1
. Description
f. Date (mm/dd/yyyy)
g. Fair Market Amount
S
(�
$ ,. vO
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Type of Contributor
❑ Individual -
❑ Candidate
❑ Party
❑ PAC
❑ Referendum
❑ Other Receipt Source
c. Comments
-
d. Flection Sum to Date
$
e. Description
f. Date (mm/dd/yyyy)
1g. Fair Market Amount
$
$
3. Contributor Information ❑ Add ❑ Remove
. Full Name, Mailing Address & Phone
(include city, state, & zip)
GOUNN
UNION FINANGE
CAMPAIGN
b. Type of Contributor
❑ Individual
❑ Candidate
❑ Party
❑ PAC
❑ Referendum
E3 Other Receipt Source
c. Comments
d. Election Sum to Date
$
e. Description OCT
f. Date (mm/dd/yyyy)
g. Fair Market Amount
$
4. Total only this Page
$ d1i
5. Total of ALL CRO -1510 Pages
(This line must be on line 17 of Detailed Summary Page CRO -1100)
CRO -1110 NC' State Board of Flections December 2007