Smith,Sandra_2021-Org-reportAmendment
Disclosure Report Cover I ❑ Yes ® No
Use this form for general report and committee information, must be signed and submitted along with o e—erMailed forms.
Do not use this form to update information
a. Full Name
c. ID Number
Sandra Smith For Clerk Committee
b. Mailing Address (include City, State and Zip Code)
d. Date Filed
4706 Nesbit Rd
Monroe, NC 28112
Z/ 7 2bZ'
e. Phone Number
704-291-0806
0 2-1 2-012J
I tI I�b�1 sandsBNnrris
F I l
one tate '
® Candidate Campaign ❑ Party
Municipal Statelcowty
Referendum
❑ PAC ❑ Referendum
❑ Organizational ® Organizational
Organizational
Independent d
F
Jont Fundraiser
❑ Expenditure ❑ i
five da
❑ Thirty-five Y Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
Pre-primary First
❑ Final
❑ "Booster Fund"
❑ Pre-election ❑ Second
❑ Supplemental Final
❑ Building Fund
❑ pre -runoff ❑ Third
❑ Annual
Semi-annual ❑ Fourth
❑ Special
❑ Mid Year Semi-annual
® Other
❑ Year End ❑ Mid Year
❑ Final ❑ Year End
❑ Special ❑ Final
0
1❑ Special
a. Financial Institution Full Name
a. Financial Institution Full Name
.American Bank
b. Purpose
c. Account Code
b. Purpose
c. Account Code
Campaign
UNIUTI "Ce
FINANCE
CAMPAIGN
DEC 0 2021
it. Period Begin Balance
d. Period Begin Balance
$ 0
$
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 other non -disclosed funds. I further certify that this report
is complete, true and correct and that I have been trained by the NC tate Board of ctions.
Sandra B Norris
12/06/2021
Printed Name of Signer
Signature of Appointed Treasurer
Date
FOR OPPICh USE ONLY I
Date Received: /a1 -7 a %
Employee:
Delivery Method
❑ Normal Mail
Date Postmarked:
Employee:
Registered Mail
Rand Delivered
Date Scanned:
Employee:
❑ Electronically Filed
❑ Signer has not received
! /
mandatory training
Date Data Entered:
Employee:
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 Summary Amendment es ® No
Use this form to summarize all disclosure reporting forms and to total monetary information.
Sandra Smith For Clerk Committee Organizational
Start of Election Cycle: January 1,
2019
Total this
Reporting Period
Total this
Election Cycle
4)
Cash on Hand at Start
$
0
$
0
5)
Aggregated Contributions from Individuals
(CRO -1205)
$
0
$
0
6)
Contributions from Individuals
(CRO -1210)
$
0
$
0
7)
Contributions from Political Party Committees
(CRO -1220)
$
0
$
0
8)
Contributions from Other Political Committees
(CRO -1230)
$
0
$
0
9)
Loan Proceeds
(CRO -1410)
$
0
$
0
10)
11)
Refands/Reimbursements To the Committee
Other Receipt Sources
Ila) Interest on Bank Accounts
(CRO -1240)
(CRO -1250)
$
0
$
0
$ 0 $
0
1 lb) Contributions from Not -for -Profit Organizations
(CRO -1250)
$
0
$
0
l lc) Outside Sources of Income
(CRO -1250)
$
0
$
0
1 l d) Legal Expense Fund — Other Sources
(CRO -1270)
$
0
$
0
11 e) Exempt Purchase Price Sales
(CRO -1265)
$
0
$
0
12)
13)
TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10, Ila, I Ib, I Ic, I Id and Ile)
Disbursements
$
0
$
0
13a) Operating Expenditures
(CRO -1310)
$
0
$
0
13b) Contributions to Candidates/Political Committees
(CRO -1310)
$
0
$
0
13c) Coordinated Party Expenditures
(CRO -1310)
$
0
$
0
14)
Aggregated Non -Media Expenditures
(CRO -1315)
$
0
$
0
15)
Loan Repayments
(CRO -1420)
$
0
$
0
16)
Refiinds/Reimbursements From the Committee
(CRO -1320)
$
0
$
0
17)
In -Kind Contributions
(CRO -1510)
$
0
$
0
18)
TOTAL EXPENDITURES (Add lines 13a,13b,13c,14,15.16 and 17)
$
0
$
0
19)
Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18)
$
$
0
0
iii
20) Non -Monetary Gifts Given to Other Committees (CRO -1330)
21)
Outstanding Loans (incl. ones from other campaigns)
(CRO -1430)
$
$
0
0
22) Debts and Obligations owed By the Committee (CRO -1610)
23)
Debts and Obligations owed To the Committee
(CRO -1620)
$
0
24)
Account Transfers Within the CommitteeCOUNTY
E
(CRO -1720)
$
$
0
0
$
0
11 4G
25) Administrative Support CAMpA1GN (CRO -1710)
26)
27)
28)
Forgiven Loans OEC O 1 v(ceo
48 -Hour Notice Reports Stmt p
Contributions to be Refunded REG
1440)
(CRO -2220)
(CRO -1215)
$
0
$
0
$ 0 $
0
$ 0 $
0
CRO -1100 NC State Board of Elections August 2008