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Smith,Sandra_2021-Year-endDisclosure Report Cover ❑ Yes Amendment No Use this form for general report and committee information, must be signed and submitted along with other clatatied fors. Do not use this form to update information a. Full Name c. TD Number Sandra Smith For Clerk Committee b. Mailing Address (include City, State and Zip Code) d. Date Filed 4706 Nesbit Rd Monroe, NC 28112 01/28/2022 e. Phone Number 704-291-0806 2;2021 Sandra B Norris 12/06/21 12/31/21 ampaign ❑Party Municipal stawcounty Referendum ❑ Referendum ❑ Organizational ® Organizational ❑ Organizational ❑ Expenditure ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fwd ® Pre-primary ❑ First ❑ Final ❑ 'Booster Fund" ❑ Pre-election ❑ Second ❑ Supplemental Final ❑ Building Fund ❑ Pre-mnom ❑ Third ❑ Annual Semi-annual ® Fourth ❑ Special ❑ Mid Year Semi-annual ® Other ❑ Year End ❑ Mid Year ❑ Final ❑ Year End ❑ Special ❑ Final 0 ❑ Special a. Financial Institution Full Name a. Financial Institution Full Name American Bank b. Purpose c. Account Code b. Purpose c. Account Code Campaign 1 d. Period Begin Balance d. Period e $: $ 0 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 NCS tate Board of Elections. Sandra B Norris J. 75 `0"6!z 01/28/2022 Printed Name of Signer Signature of Appointed Treasurer Date FOR OFFICE USE ONLY \1311 �- Delivery Method Date Received: a Employee: �((_ ❑ Normal Mail Date Postmarked: �� Employee: -- ,Registered Mail . Hand Delivered ,.., Date Scanned: Employee: E] Electronically Filed ❑ Signer has not received I l / ining mandatory traNTY Date Data Entered: Employee: UNION COUNTY fr, Please Note: This for cannot be used to amend committee information such as the committee address, treasurer, assistant treasurer, custodian of books information, or account information. IAN 3 1 2022 You must amend the Statement of Organization (CRO -2100A -E) to make committee changes. CRO -1000 NC State Board of Elections Ir C U CI V Lx� 2008 Amendment Detailed Summary [I Yo ® No Use this forth to summarize all disclosure reporting forms and to total monetary information. CRO -I 100 rvc sure Mara or tetewtam e Sandra Smith or Clerk CommitteeOrganizations] T�� Start of Election Cycle: January I, 2019 Total this Reporting Period Total this Elation Cycle 4) S) 61 7) 8) 9) 10) ll) Cash on Hand at Stan Aggregated Contributions from Individuals Contributions from Individuals Contributions from Political Party Committees Contributions from Other Political Committees Loan Proceeds Refunds/ReimbursementsTO the committee Other Receipt Sources - I la) Interest on Bank Accounts I lb) Contributions from Not -for -Profit Organizations Ilc) Outside Sources of Income IId) Legal Expense Fund—Other Sources 11 e) Exempt Purchase Price Sales (CRO -1205) ICRO-1210) (CRO- 1220) (CRO -1230) (CRO -1410) (CRO -1240) iCRo-1250) (CRO -1250) iCRO.1250) (CRO -Ino) (CRO -1265) S S 0 0 S $ 0 0 $ 84.40 S 84.40 S 0 S 0 S 0 $ 0 S 1375.78 $ 1375.78 S 0 $ 0 S 0 $ 0 S 0 S 0 S 0 S 0 S 0 S 0 S 0 $ 0 12) 1) 14) 15) 16) 17) TOTAL RECEIPTS (Add lino 5.6,7.8,9, 10, ua. 1 ub. nc, l la and ne) Disbursements 13a) Operating Expenditures (CRO -1310) 13b) Contributions to CandidatesMolitical Committees (CRO -1310) 13c) Coordinated Party Expenditures (CRO -1310) Aggregated Non -Media Expenditttrea (CRO -1315) Loan Repayments (C110-1420) RefundsiReimbursements From the Committee (CRO -1320) In -Kind Contributions (CRO -1510) S 1452.18 S 1452.18 S 1275.78 S 1275.78 $ 0 S 0 S 0 $ 0 $ 0 S 0 $ 0 $ 0 $ 0 $ 0 S 0 S 0 18) TOTAL. EXPENDITURES (Add liars 13a. Iib. 13e, 14. 15,16 and 17) S 1275.78 S 1275.78 19) Cash on Hand at End (Add lines 4 and 12 together- then subtract line 18) $ S S S S S 176.40 0 1375.78 0 0 0 S 176.40 20) 21) 22) 23) 24) 25) 26) 27) 28) Non -Monetary Gifts Given to Other Committees Outstanding Loans (incl. ones from other campaigns) Debts and Obligations owed By the Committee Debts and Obligations owed To the Committee Account Transfers Within the Committee Administrative Support Forgiven Loans 48 -Hour Notice Reports Sum Contributions to be Refunded (CRO -1330) (CRO -1430) (CRO -1610) (CRO -1620) (CRO -1720) (CRO -1710) (CRO -1440) (CBO -2220) (CRO -1215) S 0 S 0 S 0 $ 0 S 0 $ 0 $ 0 S 0 •'IMO CRO -I 100 rvc sure Mara or tetewtam e Aggregated Contributions from Individuals Aar dmeni ggre g Page I of 1 ❑ Yes ® No Optional forst used to report NC Contributions From Individuals of $50 or less CRO -12 5 NC State Board of Ekcliom Pa an a mt or ark committee LIM a. Anand Codeo. Porn ofllgal(tet �� ) L Amount P -- Add 1 Cash 12/14/2021 S 23.36 Remove ❑ Add 1 Cash 12/14/2021 S 1.04 Remove El Add $ Remove Add $ Ren c Add $ Remove Add $ Remove Add $ Remove ❑ Add $ Remove Add $ Removc Add $ Remove Add $ ❑ Remove Add $ Rmmve Add $ Ren ove Add $ _ Remove Add $ Remove Add ❑ $ _ ❑ Remove Add $ Remove cl Add $ Remove ❑ _.. Add .- $ El ---^ Remove Add $ Remove Add $ Remove ❑ Add $ ❑ Re o 4. Total only this Page 5. Total of ALL CRO -1205 Pages (This line nW be on raw 5 of DaWW %=may gage tkD-1190) $ 24.40 A'12007 CRO -12 5 NC State Board of Ekcliom Pa Contributions from Individuals re , or I ❑ Yp Use this form to report individual contributions over $50 or contributions under S50 if form CRO 1205 is not used Sandrn Smith for Clerk Committee we ce No Job Title 4510 Unionville Rd Monroe, NC 28110 p oye 704-5067675 S 60.00 ® I Cash 1130/2021 $ 40.00 ® 1 Ceah 12/31/2021 S 20.00 ❑ S — b ❑ S ❑ S S ❑ S ❑ $ Disbursementst° yes Pg I of � I Ya No Uw this form to report expenditures from the committee for, operating expenses, Contributions [o canliidate po hCa committees and coordinated party expenditures. SmithSandm or aark comainittee C b Commaea Onion "Ountyo ❑ Caordimted pasty ap®dWra 3166 East Windsor St Mourne, NC 28112 ❑ Fedmal ® County 704-283-3809 ❑ sum Munxtpahty S 1208.00 I Check H 12W 2021 $1208.00 itin8 Fee S ❑ Fedael ❑ county: ❑ sum ❑ Muvuipalay. i S $ pedead ❑ cacouq: ❑ suit ❑ Municipality. S S $ I (T1us line goes in lire t 3a of Detailed Summery Page CRO -I 100 if OP ting Expenses) $ 1208.00 (This line goes in line 136 of Detailed Sunmury Page CRO -I 100 ifComnb to Cm Widate✓Political Comm) (This linegoa in line 13c of Dc ailod Summery Page CRO -1100 if CoordineW Party Expenditures) - n o er .ant e 1 -pat alties Qa -Donation to Legal Expense Fund NC Son -BMW of becitions Dm mber 2009 A®edwad Disbursements Pg I of I E]� res Use this form to reportexpenditures from the committee for; operating expenses, contributions to candidatelpoNti — committees and coordinated perry expenditures. TiCSffie BOOM &-Ibo om mith Committee te ContrMdm to C ❑ payno atpowitures https://www.wix.com Fd" County: ❑ State ❑ Miairipalit $ 34.95 1 i Credit Card A 12/12/2021 $19.00 Fee 1 Credit Card A 12/12/2021 $15.95 Website p Fee e 1030 W Roosevelt Blvd Monroe, NC 28110 ❑ F ❑ Stete ❑ Muricq eliry $ 32.83 1 Cash A 12/09/2021 $32.83 Print MediaE Fedm1 Canty: ❑ so& ❑ Muni i*iry: $ 5 67.78 (This lix hoes in Wm 13e of Deland Summary Page PI100 trOpeeting Fnpen w;) $ 67.78 (This line gow in live 13b of Deeded Suoumry Page CRP1100 ifComrb ro Candideres/Pabtiul Comm) (Tbis lim goes m line 13c of Dote W Snmouy, Page CRP 1100 if Coordinated Pay Eitpaudiuuo) - o 0 - Foment Forty 1 • P d Qa - to Legal Expaue Fund TiCSffie BOOM &-Ibo om VOTE NORTH CAROLINA UM STATE BOARD OF ELECTIONS Loan Proceeds Statement This Statement is used to report detailed information about a new loan and is required to accompany the Loan Proceeds Form in the report for which the loan is initially disclosed. If the loan is from an individual, the lender's signature is required on this form. This Statement is to be filed with the Election Board where the committee's reports are filed. • Name of committee to receive loan: Sandra Smith for Clerk Committee • Person or committee to make loan: Sandra Smith • Date of loan to committee: 12/06/2021 • Name of lending institution (source): • Amount of loan: 1367.78 • Description (if in-kind loan): • Names of all parties responsible for payment of loan (guarantors): • Period of loan: • Rate of interest of loan: • Security pledged for loan: Sandra Smith acknowledge that all of the information (Person lending money to committee) providgd is complete, true, and accurate. I further understand I may not forgive a loan that an outstandin at to any source. \TWs 2�� 01-26-2022 Signature of Lender Date Signed 4' �s . 01-26-2022 Signature of Treasurer of Committee Date Signed CRO -6100 Loan Proceeds Statement Loan Proceeds pg I of Amendment ----� , ❑ yes No Use this form to report proceeds from a loan and loan endorser's information A loan proceeds statement must accompany each loan that is from an individual Sandra Smith For Clerk Committee a. Full Name, Mailing Address & phone Job TitleiProfessioa (include city, state, &zip) [; ni—on County Candidate Sandru fib' Smith Magistrate 4706 Nesbit Rd e. Stan Date (mmldd/yyyy) Monroe, NC 28112 704-292-4086 Ci FaoploYm's NamdSpeoiSc field State of North I '06/2(121 Carolina f. End Data (mm/dd/yyyy) 1. Rate a . '1 "'} .. ,. - . a. }... k-Amount '6 1367.78 0 % 1 Check <m. Loan Number a;.„1... e. ihnplayees NuWSpwffc Field (includec�r'. d. Praicerdage c. Amount S % a Full Name, Mailbq;Address &Pborc- - `hJebtidel itof uilon c, Employer's Name'Specifk Field (include city, state, & zip) . 'i :.�, 3r d im e. Amount % S a, Full Name, Mailing Addmas & Phone - h, Job 41tldprofesirm c. Eruployes NameSpecific Field (include city, mete. &moi) .— d. Percentage - C. Amount a. Fug Name, MaI ftAd*mA Phone b�,IQ4 itldprtofAOsiotc -_ c. Employes Name/Specific Field _ (include city. state,&zipl.' d. Pemaxagc e. Amount —_ S % S 1367.78 CRO-1410 NC State Board of Elections April 200 i