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Smith,Sandra_2021-YearEnd-amendDisclosure Report Cover ❑ NoUse this form for general report and committee information, must be signed and submitted along wiJjtj nuns. Do not use this form to update information a. Full Name c. MNumber 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 Sandra B Norris 2021 12/06/21 12/31/21 ® Candidate Campaign ❑ Party Municipal Suda/Cotnty Referendum ❑ PAC ❑ Referendum ❑ Organizational ® Organizational ❑ Organizational x ❑ Joint Fundraiser ❑ Thirty-five day ❑ Expenditure turet Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ® Pre-primary Cl First ❑ Final Cl "Booster Fund" ❑ Pre-election ❑ Second ❑ Supplemental Final ❑ Building Fun ❑ Pre-mrotT ❑ 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 Begin Balance S 0 S CERTIFICATION 1 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, we and correct and that I have been trained by the N State Board of Elections. Sandra B Norris `�{�� 02/15/2022 Printed Name of Signer Signature of Aptninted Treasurer Date Delivery Method Date Received: Employee: ❑ Normal Mail Date Postmarked: Employee: �a Registered Mail Hand 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 ® vetNo Use this form to summarize all disclosure reporting forms and to total monetary information. Sandra Smith For Clerk Committee 0 Organizational Start of Election Cycle: January 1, 2019 _ Total this Reporting Period Total this Election Cycle 4) 5) Cash on Hand at Start Aggregated Contributions from Individuals (CRO -1205) $ $ 0 0 $ $ 0 0 6) Contributions from Individuals (CRO -1210) $ 84.40 $ 84.40 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) $ 1367.78 $ 1367.78 10) Refunds/Reimbursements To the Committee (CRO -1240) $ 0 $ 0 11) Other Receipt Sources l l a) Interest on Bank Accounts (CRO -1250) $ 0 $ 0 l lb) Contributions from Not -for -Profit Organizations (CRO -1250) $ 0 $ 0 I lc) Outside Sources of Income (CRO -1250) $ 0 $ 0 lid) Legal Expense Fund — Other Sources (CRO -1270) $ 0 $ 0 11 e) Exempt Purchase Price Sales (CRO -1265) $ 0 $ 0 12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10, Ila, I lb, I lc, 1ld and Ile) $ 1452.18 $ 1452.18 13) Disbursements 13a) Operating Expenditures (CRO -1310) $ 1275.78 $ 1275.78 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) Refunds/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) $ 1275.78 $ 1275.78 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract tine 18) $ $ 176.40 0 $ 176.40 20) Non -Monetary Gifts Given to Other Committees (CRO -1330) 21) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) $ 1367.78 22) Debts and Obligations owed By the Committee (CRO -1610) $ 0 23) Debts and Obligations owed To the Committee (CRO -1620) 24) Account Transfers Within the Committee (CRO -1720) $ 0 $ 0 25) Administrative Support (CRO -1710) $ 0 $ 0 26) 27) 28) Forgiven Loans 48 -Hour Notice Reports Sum Contributions to be Refunded (CRO -1440) (CRO -2220) (CRO -1215) $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 CRO -1100 NC State Board of Elections August 2008 Amendmei Aggregated Contributions from Individuals N&C , o1 I ❑ Yes ® NO Optional form used to report NC Contributions From Individuals of $50 or less CRO- 1205 NC Start Board of elections v <w Sandra mt ForCommittee ILIVID a. Amend cQ& a., ofR�k .. (WEV ) LAmmon Add 1 Crib 12/14/2021 E 23.36 — Rcmovc ❑ Add 1 Cash 12/14/2021 S 1.04 Remove Add E Remove Add E Removc Add E Remove Add E Remove Add E Remove ❑— Add E Rerteve Add S Remove El Add E ❑ Remove ❑ Add E ❑ Remove Add Em Reove Add S Remove Add E El Ranove cl Add E Rn ove ❑ Add E Rmeve Add E Remove Add E Remeve ❑ Add E Remove Add E ❑ Remove Add E Remove ❑ Ada S Remwc 4. Total only this Page E za. io 5. Total of ALL CRO -1205 Pages (rw hm vest be oa mA s Of neuned saMey PW C1' 1100) E 24.40 CRO- 1205 NC Start Board of elections v <w Fj N. Contributions from Individuals Pg 1 of , O Y ` Use this form to report individual contributions over $50 or contributions under SSO if form CRO 1205 is not used Sandra Smith for Clerk Committee ce No Job Title 4510 Unionville Rd Monroe, NC 28110 Not Employed 704-506-7675 5 60.00 ® 1 Cash 1130/2021 S 40.00 ® I Cash 12/3112021 S 2000. ❑ $ -- s ❑ s ❑ s ❑T $ s ❑ s ❑ s ❑ s S 60.00 Loan Proceeds Pg I of f p_ Mess M No Use this form to report proceeds from a loan and loan endomes information A loan proceeds statement must accompany each loan that is from an individual Sandra Smith For Clerk committee e. Full Nerve, Mailing Addm-s At Plane b. Job TkIiiTioresisien (include city, shtq,&zip) Union County Candidate _ Sandra W Smith Magistrate, 4706 Nesbit Rd- e. Stan Date ( ) Monroe, NC 28112 704-292-4086 Cc. Emp�oyes's NatodSpeci&c Heid .)late n Nonh I'_.Y)6/2021 Carolina r End pale (mm14yyyyy) g. Rete h. Soourity i. Account Codej.om of Payment k- Amoum —� I Check 7 1;67.78 1. Full Name of Lending btclibuion ,c k.,:. in. Loan Number a. AIY ldaite,` ^ e Employees NamdSpeci6e Field - (ittohdacigr, ; -- d. Peke e. Amount a. Full Name, Mailing Addroe; &Phtmc b. )ob TitleRhofagtoo - e. Employers Name'Spwfic Field (include city. NaM & zip) e. Amount a. Furl Name, Mailing Addiru & Phan b. Job Tatdhal feanon �•.. Employers NanwSpecific Field (include city. state, &Tip)_. -- i d. Peteentege ° w a. Full Nam, MaiftA ddew & Phone 6,.101?.-. itldPmfeaeian c. Employers NamdSpecific Field (include city. stare, &zip). --_- d. Percentage e.Anwunt _--_ ii EE.78 CRO -1410 NC State Board of Elections April't>n7 Disbursements Pg Use this forto rt ex totes from the committee for; of m 13 Ya No � committees and coordinated party expenditures. operating expenses, coDmbutiotts to canttid llUCal� Smith or Committee Experwra Contributions m C an&ddb ditiwl Co W PMydowtm 316-8 East Wmdaor St Monroe, NC 28112 ❑ pedaeel l:o�y: 704-283-3809 ❑ stns ❑ munwigiaw.. S 1208.00 1 Check H 12/07/2021 $1208.00 Filing Fee S Federal ❑ Ow w ❑ Subs ❑ Mm. ipali y: $ S s ❑ Sam ❑ Coma: Mumcipality: s s S flbis live goal in line 13s of DetWod Su am y Page CRC -1100 if Opcmtutg P.apenees) (lois line gow m line Ob of Detailed Su000ar) Page CRC) -1100 dCootdb to CandAdca?olitieal Croom) S 1208.00 ('Ibis lire go in Iim13c of Deerilod Sumoerry Page CRO4100 ifCooidioOod Pwty 8xpevdht ) g nther Candidate es 1 - Penalties Qa -Donation to Legal Expense Fund NC swe Bond of Owborts December 1-109 Disbursements pg , of Yac Use this form to report expenditures from the committee for operatinR expenses, contributions to candidaer imeT WIX Store https://www.wbt.com ❑ P Cama" ❑ Sede ❑ Mwiaowft: S 34.93 I Credit Care! A 12/12/2021 $19.00 webeftmooft Fee 1 Crecht Card A 12/12!2021 $15.95 a site Setup Fee 1030 W Roosevelt Blvd Monroe, NC 28110 ❑ padeal Camey: ❑ SWe ❑ Mmicipeliry: S 32.83 1 Cash A 12/09/2021 532.83 Print In $ ❑ ss ❑ Munellaw: S $ ;(Thi;sijmgminlZ=13sofDotafledSumawYPWCRO-llooifopmft&pe S 67.73 yPapenw)mgooioIme 13bofDashedSu®ypMCRO.1100ifca�mC.odidLLer hticalcomm! $ 67.78 ino gon m Jillof Dd:=W Suc®)FhV CRt11100 if Cmdh@W Paty Egmdmua) Q an eg imece J • penalties Q" - to Legal Expense Fund aNORTH CAROLINA 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's an outstandin al to any source. \��� _ 01-26-2022 Signature of Lender Date Signed L a1xJjLLj _ 01-26-2022 Signature of Treasurer of Committee Date Signed CRO-6/00 Loan Proceeds Statement