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Smith,Sandra_2022-1st-qtrAmendment Disclosure Report Cover E'Yes ® No Use this form for general report and committee information, must be signed and submitted along with o ere a orms. Do not use this form to update information a. Full Name a m Number Sandra Smith For Clerk Committee b. Mailing Address (include City, State and Zip Code) it. Date Filed 4706 Nesbit Rd Monroe, NC 28112 05/10/2022 e. Phone Number "2021 704-291-0806 Sandra B Norris 01/01/22 04/30/22 ® Candidate Campaign ❑ Party Municipal staftcounty Ref re dun ❑ PAC ❑ Referendum ❑ Organizational ® Organizational ❑ Organizational Independentfive El Expenditure E) Joint Fundraiser da Thi ❑ M- Y Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ® Pre-primary ® First ❑ Final ❑ 'Booster Fund" ❑ Pre -elation ❑ Second ❑ Supplemental Final ❑ Building Fund ❑ Pre-rousaff ❑ 'third ❑ Annual Semi-annual ❑ Fourth ❑ Special ❑ Mid Year Semi-annual ® Other. ❑ Year End ❑ Mid Year MMM ❑ 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. Purpose7UnionCo. out Code Campaign 1 2 d. Period Begin Balance d. P Begin Balance ' $ 176.40 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 NC §tate Board of Electi ns. Sandra B Norris 05/10/2022 Printed Name of Signer Signature of Appointed Treasurer Date FOR OFFICE USE ONLY Delivery Method Date Received: O a� Employee: ❑ Normal Mail Date Postmarked: Employee: ❑ Registered Mail Hand Delivered Electronically Filed Date Scanned: —T– I Employee: ❑ 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 Amendment Detailed Summary t] Yes ® No Use this form to summarize all disclosure reporting forms and to total monetary information. CRO -1100 NC State Board of elections August cove Sandra Smith For Clerk Committee 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) S 176.40 $ 0 $ 3429.70 $ 3429.70 6) Contributions from Individuals (CRO -1210) $ 3932.70 $ 4017.10 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) $ 2173.03 $ 3540.81 10) Refunds/Reimbursements To the Committee (CRO -1240) $ 0 $ 0 11) Other Receipt Sources 11 a) Interest on Bank Accounts (CRO- 1250) $ 0 $ 0 11b) Contributions from Not -for -Profit Organizations (CRO -1250) $ 0 S 0 11c) Outside Sources of Income (CRO -1250) $ 0 S 0 11d) 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 lb, l lc, l Id and Ile) Disbursements $ 9535.43 $ 10987.61 13a) Operating Expenditures (CRO -1310) $ 7410.13 S 8685.91 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 -I420) $ 0 $ 0 16) Refunds/Reimbursements From the Committee (CRO -1320) $ 0 $ 0 17) In -Kind Contributions (CRO -1510) S 1233.00 $ 1233.00 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14,15,16 and 17) $ 8643.13 $ 9918.91 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18) $ S $ S 1068.70 0 3540.81 0 $ 1068.70 20) Non -Monetary tufts Given to Other Committees (CRO -1330) 21) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) 22) Debts and Obligations owed By the Committee (CRO -1610) 23) Debts and Obligations owed To the Committee (CRO -I620) $ 0 24) Account Transfers Within the Committee (CRO -1720) $ 0 25) Administrative Support (CRO -1710) $ 0 $ 0 26) 27) 28) Forgiven Loans 48 -Hour Notice Reports Slim Contributions to be Refunded (CRO -1440) (CRO -2220) (CRO -1215) S 0 $ 0 $ 0 $ 0 $ 0 $ 0 CRO -1100 NC State Board of elections August cove Amendment Aggregated Contributions from Individuals Page I of 6 ❑ Yes ® No Optional form used to report NC Contributions From Individuals of $50 or less Sandra Smith For Clerk Committee a. Amend CodeCOW c. Form of Payment Description (mm/dd/ YYYY) f. Amount ❑ Add 1 Cash 01/27/2022 $ 10.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 20.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 20.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 20.00 ❑ I Remove 1] Add 1 Cash 03/04/2022 $ 20.00 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 30.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 20.00 ❑ Remove F-1 Add 1 Cash 03/04/2022 $ 20.00 ❑ I Remove ❑ Add 1 Cash 03/04/2022 $ 40.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 20.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 10.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 45.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 50.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 40.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 20.00 n Remove ❑ Add 1 Cash 03/04/2022 $ 20.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 20.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 20.00 ❑ Remove El Add 1 Cash 03/04/2022 $ 45.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 40.00 ❑ Remove ❑ Add 1 Cash 03/04/2022 $ 40.00 ❑ Remove ❑ Add I Cash 03/04/2022 $ 40.00 ❑ Remove 4. Total only this Page $ 610.00 5. Total of ALL CRO -1205 Pages (This line must be on tine 5 of Detailed Summary Page CRO.1100) $ 3429.70 CRO -1205 NC State Board of Elections April 2007 Amendment Aggregated Contributions from Individuals Page 2 of 6 p Yes ® No j Optional form used to report NC Contributions From Individuals of $50 or less tizmdIa Smith For Clerk Committee a Amend Cade C. Pow ofPaymmt Descriptioa (non1dd/yM) f. Amount p Aad 1 Cash 03/04/2022 $ 30.00 p Remove p Add 1 Cash 04/02/2022 $ 15.00 p Remove El Add 1 Cash 03/04/2022 $ 50.00 El Remove El Add 1 Cash 03/04/2022 $ 20.00 Fl Remove El Add 1 Cash 03/04/2022 $ 50.00 El Remove p Add 1 Cash 04/02/2022 $ 20.00 p Remove p Add 1 Cash 03/04/2022 $ 25.00 p Remove El Add 1 Cash 03/04/2022 $ 20.00 p Remove El Add I Cash 03/04/2022 $ 40.00 El Remove p Add 1 Cash 03/05/2022 $ 40.00 Fl Remove p Add 1 Cash 03/05/2022 $ 25.00 p Remove p Add 1 Cash 03/05/2022 $ 20.00 p Remove p Add 1 Cash 03/05/2022 $ 20.00 p Remove p Add 1 Cash 03/04/2022 $ 20.00 El Remove p Add 1 Cash 03/04/2022 $ 20.00 Fl Remove El Add 1 Cash 03/04/2022 $ 40.00 p Remove El Add 1 Cash 03/04/2022 $ 20.00 p Remove p Add 1 Cash 03/04/2022 $ 40.00 p Remove p Add 1 Cash 03/04/2022 $ 40.00 p Remove El Add 1 Cash 03/04/2022 $ 30.00 p Remove p Add 1 Cash 03/04/2022 $ 20.00 E] Remove p Add 1 Cash 03/04/2022 $ 30.00 p Remove 4. Total only this Page $ 635.00 5. Total of ALL CRO -1205 Pages (This line most be on line 5 of Detailed Summary Page CRO -1100) $ 3429.70 CRO -1205 NC State Board of Elections APnr 2W / Amendment Aggregated Contributions from Individuals Page 3 of b ] Yea ® No Optional form used to report NC Contributions From Individuals of $50 or less Sandra Smith For Clerk Committee a. Amend b. Code c. Forth of Payment d.M-Kmd Desenpion e. }; Amount Add 1 Cash 03/05/2022 $ 40.00 ❑ Remove ❑ Add 1 Cash 03/05/2022 $ 40.00 Remove ❑ Add 1 Cash 03/05/2022 $ 20.00 El Remove Add I Cash 03/05/2022 $ 40.00 Remove Add I Cash 03/05/2022 $ 40.00 Remove 0 Add 1 Cash 03/05/2022 $ 40.00 El Remove ❑ Add 1 Cash 03/05/2022 $ 25.00 Remove Add I Cash 03/05/2022 $ 40.00 Remove Add I Cash 03/05/2022 $ 40.00 Remove ❑ Add I Cash 03/05/2022 $ 20.00 ❑ Remove ❑ Add 1 Cash 03/05/2022 $ 20.00 Remove Add 1 Cash 03/05/2022 $ 40.00 El Remove Q Add 1 Cash 03/05/2022 $ 20.00 Remove Add 1 Cash 03/05/2022 $ 20.00 Remove El Add 1 Cash 03/05/2022 $ 20.00 11 Remove ❑ Add 1 Cash 03/05/2022 $ 20.00 Remove Add 1 Cash 03/05/2022 $ 40.00 Remove Add 1 Cash 03/05/2022 $ 40.00 ❑ Remove ❑ Add 1 Cash 03/05/2022 $ 20.00 El Remove 0 Add 1 Cash 03/05/2022 $ 40.00 ❑ Remove ❑ Add 1 Cash 03/05/2022 $ 40.00 ❑ Remove ❑ Add 1 Cash 03/05/2022 $ 40.00 El Remove 4. Total only this Page $ 705.00 5. Total of ALL CRO -1205 Pages (This line moat be on line 5 of Detailed Summary Page CRO.1100) $ 3429.70 CRO -1205 NC State Board of Elections Apnl 2007 Amendment Aggregated Contributions from Individuals Page 4 of b p Yes ® No Optional form used to report NC Contributions From Individuals of $50 or less Sandra Smith for C er Committee ✓< Aid b. Code c. Fomt of Payment d. Dewription Kmd (�tadtyM) f Amount ❑ Add 1 Cash 03/05/2022 $ 20.00 ❑ Remove Add 1 Cash 03/05/2022 $ 20.00 ❑ Rentuve Add 1 Cash 03/05/2022 $ 20.00 El Remove M Ada 1 Cash 03/05/2022 $ 20.00 El Remove El Add 1 Cash 03/05/2022 $ 40.00 El Remove ❑ Add 1 Cash 03/05/2022 $ 50.00 11 Remove El Add I Cash 03/05/2022 $ 40.00 El Remove F1 Ada 1 Cash 03/05/2022 $ 40.00 Remove p Add 1 Cash 03/05/2022 $ 20.00 ❑ Remove ❑ Add 1 Cash 03/05/2022 $ 20.00 ❑ Remove n Add 1 Cash 03/05/2022 $ 30.00 ❑ Remove ❑ Add 1 Cash 03/05/2022 $ 40.00 ❑ Remove ❑ Ada 1 Cash 03/05/2022 $ 40.00 p Remove 11 Add 1 Cash 03/05/2022 $ 20.00 1] Remove p Add 1 Cash 03/05/2022 $ 20.00 p Remove ❑ Add 1 Cash 03/05/2022 $ 20.00 ❑ Remove ❑ Add 1 Cash 03/05/2022 $ 20.00 p Remove Add 1 Cash 03/05/2022 $ 30.00 ❑ Remove Add 1 Cash 03/05/2022 $ 20.00 p Remove p Add 1 Cash 04/02/2022 $ 20.00 El Remove Add 1 Cash 04/02/2022 $ 15.00 ❑ Remove ❑ Add I Cash 04/02/2022 $ 15.00 ❑ Remove 4. Total only this Page $ 580.00 5. Total of ALL CRO -1205 Pages (This lice must be on line 5 of Detailed Summary Page CRO -1100) $ 3429.70 CRO -1205 NC State Board of Elections April 2007 Amendment --� Aggregated Contributions from Individuals Page 5 of b ❑ Yes ® No Optional form used to report NC Contributions From Individuals of $50 or less Sandra Siniih I �i t lerk Committee a. nd Amend Codeb. Ac Description c.Fomr of Payment d. In ripfion �. '•' - �: :fin, nun ❑ Add 1 Cash 04/02/2022 $ 30.00 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 30.00 ❑ Remove El Aad 1 Cash 04/02/2022 $ 40.00 ❑ Remove ❑ Add I Cash 04/02/2022 $ 40.00 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 25.00 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 25.00 El Remove ❑ Add 1 Check 04/02/2022 $ 25.00 ❑ Renaive ❑ Add 1 Check 04/02/2022 $ 25.00 ❑ Remove ❑ Add 1 Check 04/02/2022 $ 50.00 ❑ Remove ❑ Add I Check 04/02/2022 $ 50.00 ❑ Remove ❑ Add I Cash 04/02/2022 $ 32.50 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 32.50 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 25.00 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 25.00 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 35.00 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 35.00 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 15.00 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 15.00 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 50.00 ❑ Remove ❑ Add I Cash 04/02/2022 $ 50.00 ❑ Remove ❑ IAdd 1 Cash 04/02/2022 $ 50.00 ❑ Remove ❑ I Add I Cash 04/02/2022 $ 50.00 ❑ Remove 4. Total only this Page $ 755.00 5. Total of ALL CRO -1205 Pages (This line must be on fine 5 of Detailed Summary Page CRO.1100) $ 3429.70 CRO_ 1205 NC State Board of Elections Apnl 2007 I Amendment Aggregated Contributions from Individuals Page b of b p Yes ® No Optional form used to report NC Contributions From Individuals of $50 or less CRO -1205 NC State Board of Elections Apm nu t a Amari CAMM ode c. Fam ofPrymmt & MUM DMFWM�� UM ) f. Amount ❑ Add 1 Cash -Veneto 04/27/2022 $ 49.70 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 15.00 ❑ Remove ❑ Add 1 Cash 04/02/2022 $ 30.00 ❑ Remove ❑ Add 1 Cash 03/10/2022 $ 50.00 ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ 13Remove ❑ Add ❑ Remove ❑ Add ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove ❑ Add $ ❑ Remove 4. Total only this Page $ 144.70 5. Total of ALL CRO -1205 Pages (This fine must be on line 5 of Detailed Summary Page CRO -1100) $ 3429.70 CRO -1205 NC State Board of Elections Apm nu t IAmendment Contributions from Individuals Pg I of b 1 [] Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used Sandra Smith for Clerk Committee a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job TitleTrafession d. Comments Assistant Clerk Judy Macemore 1710 Eugene Hobbs Rd Monroe, NC 28110 704-226-7420 c. Employers Name/Specific Field Union County e. Election Sum to Date $ 75.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 1 Venmo-Cash 02/15/2022 $ 75.00 ❑ a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job TitWPmfession $ d. Comments Unemployed Construction Continued p.5 RB Witmore 4704 Nesbit Rd Monroe, NC 28112 704-764-3149 c. Employers Name/Specific Field e. Election Sum to Date $ 250.00 f Prior g. Account Code h Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) It. Amount ❑ 1 Cash 01/15/2022 $ 50.00 ❑ 1 Cash 01/22/2022 $ 50.00 ❑ 1 Check 03/05/2022 $ 150.00 a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Pmfession d. Comments Unemployed Homemaker Continued p.4 Linda Witmore 4704 Nesbit Rd Monroe, NC 28112 704-7643149 c. Employers Name/Specific Field e. Election Sum to Date $ 250.00 E Prior g. Account Code Jr. Form of Payment i. Io-Kmd Description j. Date (mmtdd/yyyy) It. Amount ❑ 1 Cash 01/15/2022 $ 50.00 ❑ 1 Cash 01/22/2022 $ 50.00 ❑ 1 Check 03/05/2022 $ 150.00 _ $ 575.00 '5 T $ 2699.70 CRO -1210 NC State Board of Elections April 2007 Amendment Contributions from Individuals Pg z of 6 p Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used Sandra Gmith for Clerk Committee a. Full Name, Mailing Address & Phone b. Job Title/Profession (include city, state, & zip) Unemployed Donna Price Food Sales Representative 4510 Unionville Rd c. Employer's NamdSpecific Field Monroe, NC 28110 US Foods 704-506-7675 d Comments - e. Election sum to Date $ 175.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mn/ddtyyyy) k. Amount ® 1 Cash 12/31/2021 $ 60.00 ❑ 1 Cash 03/05/2022 $ 80.00 ❑ 1 Cash 04/02/2022 $ 35.00 a. Full Name, Marling Address & Phone (include city, state, & zip) b. Job Title/Profession d. Commmta In Kin p.3 $20.00 e. Elation Sum to Date $ 160.00 Unemployed UCPS-Cafeteria Betty Goin 921 E Hwy 218 Monroe, NC 28110 704-753-1583 c. Employer's Name/Specific, Field f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 1 Cash 03/05/2022 $ 40.00 ❑ 1 Check 03/05/2022 $ 50.00 ❑ 1 Cash a. Full Name, Mailing Address & Phone (include city, state, & zip) 04/02/2022 b. Job TidaTrofession $ 50.00 d. Comments Tree Service Kevin Ahlstrom 468 Hunting Creed Rd Weddington, NC 28104 704-206-9320 c. Employers Name/Specific Field Ahlstrom's Tree Service e. Election Sum to Date $ 100.00 f Prior g. Account Code It. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ 1 Cash 03/05/2022 $ 50.00 ❑ 1 Cash 03/10/2022 $ 50.00 ❑ $ e $ 355.00 L CRO -1210 Pages : $ 2699.70 line 6 of Detailed Su CRO -1210 NC State Board of Elections Apn12UU7 Amendment Contributions from Individuals Pg 3 of b 1 ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used Sandra Smith for Clerk Committee a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Unemployed Henry Young 5301 Old Hwy Rd Waxhaw, NC 28173 704-254-2711 c. Employees Name/Specific Field e. Election Sum to Date $ 100.00 f Prior g. Account Code It. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k Amount ❑ 1 Cash 03/05/2022 $ 40.00 ❑ 1 Venmo-Cash 03/08/2022 $ 60.00 ❑ a. Full Name. Mailing Address & Phone (include city, state, & zip) b. Job Tide/Pmfession $ d. Cots Homemaker In Kind p. I $160.00 Gabrielle Wheless 97 Market Point Dr, Apt 520 Greenville, SC 29607 832-561-7617 c. Employees Name/specific Find e. Elation Sum to Date $ 284.00 f Prior g. Account Code It. Form of Payment i. In -Kind Description j. Date (mm/d&yyyy) k Amount ❑ I Cash 03/05/2022 $ 20.00 ❑ I Venmo-Cash 03/07/2022 $ 104.00 ❑ $ a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Tido/Pmfession d. Comments Tree Service e. Elation Sum to Date $ 110.00 Davis Ahlstrom 1105 Martha Dr Monroe, NC 28112 704-206-9320 c. Employees Narne/Specific Field Ahlstrom's Tree Service f Prior g. Account Code It. Form of Payment i. In -Kind Description j. Date (mm/ddlyyyy) k Amount ❑ I Cash 03/05/2022 $ 40.00 ❑ 1 Cash 03/10/2022 $ 50.00 ❑ 1 Cash 03/04/2022 $ 20.00 $ 334.00 210 $ 2699.70 CRO -1210 NC State Board of Elections April 2007 I— Amendment Contributions from Individuals Pg 4 of 6 � � Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used Sandra Smith for Clerk Committee a. Full Name, Mailing Address & Phone b. Job Title/Profession (include city, state, & zip) Cosmetologist Kayla Brooks 4705 Nesbit Rd c. Employers NamdSpecific Field Monroe, NC 28112 704320-0276 d. Comments In Kind p.2 $70,00 e. Election Sum to Date $ 110.00 f. Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount -- ❑ 1 Cash 03/05/2022 $ 40.00 ❑ $ ❑ $ a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job TitlrJPmfession d. Comments Homemaker See pg 1 for prior contributions of $250 In Kind p.4 $20.00 Linda Witmore 4704 Nesbit Rd Monroe, NC 28112 704-764-3149 c. Employers Name/Specific Field e. Election Sum to Date $ 320.00 f Prior g. Account Code h. Form of Payment i. In -Kind Description i. Date (mm/dd/yyyy) k. Amount ❑ I Cash 03/05/2022 $ 50 r i ❑ $ ❑ $ - a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments e. Election Sum to Date _ $ 952.04 Customer Service Representative Maggie Rains 4609 Rollingwood Dr Monroe, NC 28112 704-291-0049 c. Employers Name/Specific Field American Bank f Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ® I AnedotCash 12/14/2021 $ 1.04 ❑ 1 Cash 03/05/2022 $ 40.00 ❑ NOW 1 Check 03/11/2022 $ 911.00 $ 1066.00 Amendment Contributions from Individuals Pg 5 of 6 ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used Sandra Smith for Clerk Committee a. Full Name. Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments In Kind p.3 $60.00 Tommy Byrd 10319 Waxhaw Hwy Waxhaw, NC 28173 704-254-6679 c. Employers Name/Specific Field e. Election sum to Date $ 160.00 f. Prior g. Account Code h. Foot of Payment i. In -Kind Description j. Date (mm/dd/yyyy) k. Amount ❑ I Cash 03/05/2022 $ 40.00 ❑ 1 VenmoCash 03/08/2022 $ 60.00 a. Full Name. Mailing Address & Phone (include city, state, & zip) b. Job Title/Pmfestion d Comments Unemployed Construction Prior pg I total $250 RB Witmore 4704 Nesbit Rd Monroe, NC 28112 704-764-3149 c. Employers Name/Spwific Field e. Election Sum to Date $ 305.00 f. Prior g. Account Cale h. Fort of Payment i. In -Kind Description j. Date (mm/dd/yyyy) It. Amount ❑ 1 Cash 03/05/2022 $ 30.00 ❑ 1 Cash 04/02/2022 $ 25.00 ❑ a. Full Name, Mailing Address & Phone (include city, state, &zip) b. Job Title/Profession $ d. Comments Unemployed Barry Rushing 2505 Henry Baucom Rd Monroe, NC 28110 704-506-0935 c. Employers Name/Specific Field e. Election Sum to Date $ 60.00 f Prior g. Account Code It. Fort of Payment i. In Kind Description j. Date (mm/ddlyyyy) k. Amount ❑ 1 Check 04/02/2022 $ 50.00 ❑ 1 Cash 04/02/2022 $ 10.00 ❑ $ $ 215.00 2,10 Pages,. g 2699.70 ed s CRO -1210 NC State Board of Elections April 2007 Amendment Contributions from Individuals Pg 6 of 6 ❑ Yes ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used Sandra Smith for Clerk Committee a. Full Name, Mailing Address & Phone b. bb TNe/Pmfession (include city, state, & zip) Unemployed Pam Rushing Homemaker 2505 Henry Baucom Rd c. Employers Name/Specific Field Monroe, NC 28110 704-506-0935 d. Comments e. Election Sum to Date $ 60.00 f Prior g. Account Code It. Form of Payment i. In -Kind Description j. Date( It. Amount M 1 Cash 04/02/2022 $ 10.00 ❑ 1 Check 04/02/2022 $ 50.00 ❑ a. Full Name, Mailing Address & Phone (include city, state, & zip) b. lob TiddPmfession $ d. Comments Customer Service Representative Prior pg 4 total $952.04 Maggie Rains 4609 Rollingwood Dr Monroe, NC 28112 704-291-0049 c. Employers NamdSpecific Field e. Election Sum to Date $ 972.04 F . Prior g. Account Code h. Fomr of Payment i. In -Kind Description j. Date (mm/ddlyyyy) k Amount L 1 Cash 04/02/2022 $ 20.00 ❑ $ ❑ 3. C $ a. Full Name, Mailing Address & Phone (include city, state, & zip) b. lob TdldPmfession d. Comments Controller Union County Kia Angela Hill 5514 Friendly Baptist Church Rd Indian Trail, NC 28079 704-221-1779 c. Employers Name/Specific Field Union County Kia e. Election Sum to Date $ 99.70 g. Account Code h Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) It. Amount I Cash App 03/20/2022 $ 99.70 LE )$ $ $ 179.70 5. Total of ALL CR $ 2699.70 (This line must be on li mm l "( ) I '_Iii NC State Board of Elections April 2007 Amendment Disbursements Pg I of 6 ElYes ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidateipo biucar committees and coordinated party expenditures. Sandra Smith for Clerk Committee ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Parry Expenditures a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Commeots 2021—$34.95 WIX Store https://www.wix.com c. L. el Registered (Specify) E] Federal ® County: El State Municipality: e. Election Sam to Date $ 72.95 f. Account Code g. Form of Payment IL Purpose Code i. Date (nm/dd/yyyy) j. Amount k. Required Remarks Loan Credit Card A 01/12/2022 $19.00 Website Monthly Fee Loan Credit Card A 02/12/2022 $19.00 We si a Monthly Fee a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments Continued from above WIX Store https://www.wix.com c. Level Registered (Specify) ❑ Federal ® County: State El Municipality: e. Election Sum to Date S 110.95 f Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks Loan Credit Card A 03 13/2022 $19,00 Website Monthly Fee Loan Credit Card A 04/12/2022 $19.00 Website Monthly Fee a. Full Name, Mailing Address & Phone (include city, slate, & zip) b. Coordinated Committee Name d. comments Union County GOP Web c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Mectim Sam to Date $ 125.00 f Account Code g. Form of Payment ft. Purpose a i. Date (mWdd/yyyy) j. A>munt k. Required Remarks Cash A 01/31/2022 $125.00 Event Brochure Advertisement $ S 201.00 MMMM"(This line goes in lice 13a of Detailed Summary Page CRO -1100 if Operating Expenses) $ 7410.13 (This line goes in line l3b of Detailed Summary Page CRO -I 100 if Contrib to Candidates/Political Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) - a - Printing - Fundrallaing D -I o Another Candidate E - Salaries F* - Equipment G - Political Patty H* - Holding Public Office Expenses 1 - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* - Other CRO -1310 NC State Board of Elections December 2009 Amendment Disbursements Pg 2 of 6 ❑ Yes ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidat po ihc- committees and coordinated party expenditures. Sandra Smith or Clerk ommittee ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments AccountingSetup December 2021 Treasurer Tmg Rhonda H Marsh Accountant 1807 Morgan Mill Rd Monroe, NC 28110 704-289-5155 c. Level Registered (Specify) ❑ Federal ® County: ❑ State Municipality: e. Election Sum to Date $ 350.00 f. Account Code g. Form of Payment IL Purpose Code i. Date (mm/dd/yyyy) j. Amount k Required Remarks 1 Check 1003 K 01/31/2022 $350.00 Accounting Fees Dec 2021 a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments Sign Masters 314-B Depot St Monroe, NC 28112 704-225-0673 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 1697.93 f. Account Code g. Form of Payment se Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks I Debit A 02/02/2022 $1441.13 Signs with Stands 1 Debit A 03/14/2022 $256.80 Red Banners a. Full Name, Mailing Address & Phone (include city, slate, & zip) b. Coordinated Committee Name d. Comments Sports To You 108 S Hayne St Monroe, NC 28112 704282-2102 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 210.00 C Account Code g. Form of Payment 50 a i. Date (mm &yyyy) j. Amount k. Regioned Remarks I Debit A 02/03/2022 $105.00 Tshirts Debit A 02/14/2022 $105.00 (This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Detailed Summary Page CRO -1100 if Conm'b to Candidates/Political Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) Tshirts 2257.93 $ 7410.13 - Meant - Printing - Fundraising D - I o Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses I - Postage 1 - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* - Other CRO -1310 NC State Board of Elections December2009 _ - Amerxhnent is urseU 11 s Pg 3 of 6 ❑ Yes Use this form to report expenditures from the committee for; operating expenses, contributions to candidate7po hcli '� committees and coordinated party expenditures. Sandra Smi or Clerk Committee Z Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures a. Full Name, Mailing Address & Phone (include city, state, & zip) It. Coordinated Committee Name d. Comments Dollar—General 2217 Lancaster Ave Monroe, NC 28112 704-774-6735 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 54.92 f. Account Cade g. Form of Payment It. PuTpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks 1 Debit K 02/09/2022 $40.51 Table Decor for Event I oan Credit Card K 02/28/2022 $14.41 D6cor for Fundraiser ,.Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments Zazzle www.zazzle.com 888-892-9953 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 14.20 f Account Code g. Form of Payment IL rUrpoW Undo i. Date (mm/dd/yyyy) j. Amount It. Required Remarks I Debit A 02/15/2022 $14.20 Name Tag ayee orma a. Full Name, Mailing Address & Phone (include city, state, & zip) It. Coortlmated Committee Name d. Comments 2021=$32.83 OfficeMax Roosevelt Blvd Monroe, NC 28110 704-226-9977 c. Level Registered (Specify) ❑ Federal N County: ❑ State ❑ Municipality: e. Election Sum to Date $ 79.26 f. Account Code g. Form of Payment L Date (mm/dd/yyyy) j. Amount k Required Remarks 1 Debit A 02/22/2022 $12.80 Office Supplies 1 Debit A 02/21/2022 $33.63 C&tom F yens 101.14 $ 7410.13 (This line goes inline 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Detailed Summary Page CRO -1100 ifContrib to Candidates/Political Cormn) (This line goes in line 13c of Detailed Summary Page CRO -I 100 if Coordinated Party Expenditures) - Media - Printing - Fundralsing D - To Another Candidate E - Salaries F' - Equipment G - Political Party H" - Holding Public Office Expenses I - Postage J - Penalties K' - Office Expenses Q' - Donation to Legal Expense Fund O• - Other CRO -1310 NC State Board of Elections December 2009 Amendment 1S WOMWn S Pg 4 of 6 E] yes ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated party expenditures. 6 Sandra Smith for CIR Committee w 00001r- ® Operating Expenses El Contributions to CandidatestPolircal Committees E] Coordinated Party Expenditures a. Full Name, Mailing Address & Phone (include city, slate, & zip) b. Coordinated Committee Name d. Comments VistaPrint www.vistaprint.com c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Elation Sam to Date $ 4102.24 f Account Code g. Form of Payment It. Purpose code i. Date (mn✓ddtyyyy) j. Amount k. Required Remarks I Debit A 03/21/2022 $712,01 Postcards 1 Debit A 04/22/2022 $3390.23 Postcards a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments - Amazon www.amazon.com c. Level Registered (Specify) E] Federal ® County: State E] Municipality: e. Election Sum to Date $ 105.02 f. Account Code g. Form of Payment ft. Purpose Cede i. Date (mm/dd/yyyy) j. Amount k. Required Remarks Loan Credit Card A 01/26/2022 $91.16 Red Tshirts Loan Credit Card A 01/26/2022 $13.86 Event Table Decor a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name it. Comments P.3 total $46.43 OfficeMax Roosevelt Blvd Monroe, NC 28110 704-226-9977 c. Level Registered (Specify) Federal ® County: E] State E] Municipality: e. Election Sam to Date $ 103.55 f. Account Code g. Form of Payment IL nuPOse Unite i. Date (mm/d&yyyy) j. Amount L Required Remarks 1 Debit A 02/21/2022 $23.49 Custom Flyers 1 Debit A 03/14/2022 $33.63 Custom Flyers 4264.38 $ 7410.13 (This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in lure 13b of Detailed Summary Page CRO -I 100 if Contrib to Candidates/Political Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) - to - Printing - Fundranting D - I o Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* - Other CRO -1310 NC State Board of Elections December 2009 Amendment Disbursements Pg 5 of b Yes ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidal po ittca committees and coordinated party expenditures. CRO -1310 NC State Board of Elections December 2009 Sandra Smith for Clerk Committee E] Operating Expenses 4. Payee InM a. Full Name, Mailing Address & Phone (include city, state, & zip) WIRE Radio 1700 Buena Vista Rd Monroe, NC 28110 704-289-2525 Contributions to Candidates/Political Committees ❑ b. Coordinated Committee Name c. Level Registered (Specify) ❑ Federal ® County: ❑ State Municipality: Coordinated Patty Expenditures d. Comments e. Election Sum to Date $ 306.00 f Account Code S. From of Payment h. Purpose Code i. Date (mm/ddtyyyy) j. Amount It. Required Remarks I Debit A 03/18/2022 $306.00 17 Time Spots Political Ads a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments PA total $4102,24 VistaPrint www.vistaprint.com a Level Registered (Specify) Federal ® County: ❑ Slate Municipality: e. Elation Sum to Date $ 4343.21 f Account Code g. Form of Payment i. Date (tnm/dd/yyyy) j. Amount k. Required Remarks 1 Debit A 04/25/2022 $240.97 Postcards A $ a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name it. Comments PA total $103.55 OfficeMax Roosevelt Blvd Monroe, NC 28110 704-226-9977 c. Level Registered (Specify) Federal ® County: ❑ State Municipality: e. Election Sum to Date f. Account Code g. Form of Payment w a i. Date (mm/dd/yyyy) j. Amotmt k Requited Remarks l Debit A 03/22/2022 $46.70 Custom Flyers $ 593.67 $ 7410.13 (This lice goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in lice Iib of Detailed Summary Page CRO -1100 if Contrib to Candidates/Political Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) - Media - Printing E - Salaries F' - Equipment I - Postage J - Penalties O' - Other s - Fundraising G - Political Parry K" - Office Expenses D - To Another Candidate H' - Holding Public Office Expenses Q' - Donation to Legal Expense Fund 2292 CRO -1310 NC State Board of Elections December 2009 —Amendment— Disbursements Pg 6 of 6 [:]Yes ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/po tttl` cam committees and coordinated party expenditures. CRO -1310 NC State Board of Elections December 2009 SandraCle Committee enses ❑ j. Full Name, Mailing Address & Phone ( include city, state, & zip) Amazon W W W.amazon.com Contributions to Candidates/Political Committees b. Coordinated Committee Name c. level Registered (Specify) Federal ® County: ❑ State ❑ Municipality: Coordinated Party Expenditures d. Comments e. Elation Sum to Date $ 82.62 i le Code g. Font of Payment n. rurpose a i. Date (mn/dd/yyyy) j. Amount Ic Required Remarks Loan Credit Card A 02/28/2022 $-22.40 Tshirt Vinyl $ a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comm" c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Elation Sum to Date $ f. Account Code g. Fore of Payment h. Purpose Cade i. Date (mm/ddiyyyy) j. Amount k Required Remarks a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date f Account Code I g. Form of Payment se Code i. Date (mm/ddtyyyy) j. Amount k. Required Remarks (This line goes in line 13a of Detailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Detailed Summary Page CRO -I 100 if Contrib to Candidates/Political Comm) (This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) -22.40 $ 7410.13 - a - Printing E - Salaries F* - Equipment 1 - Postage J - Penalties O* - Other - Fundraising G - Political Party K* - Office Expenses D - To Anotha Candidate H* - Holding Public Office Expenses Q* - Donation to Legal Expense Fund CRO -1310 NC State Board of Elections December 2009 Amendment. .. In -Kind Contributions Pg I of 5 10 yea ® 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. Sandra Smith for C e Committee a. Full Nature, Mailing Address & Phone (include city, state, &zip) b. Type of Contributor C. Cotrttnrata ® Individual ❑ Candidate Party PAC ❑ Referendum Other Receipt Source Fundraiser 03/05/22 d. Election Stan to Date Gene Shuffler 4109 Shannamara Dr Matthews, NC 28104 704-641-0876 $ $0.00 e. Description £ Date (na /dd/yyyy) g. Fair Market Amoum Pepper Grinder 03/05/2022 $ 50.00 a. Full Name, Mailing Address & Phone (include city, state, &zip) b. Type of Contributor c. Comments ® Individual ❑ Candidate ❑ Party ❑ PAC Ej Referendum Other Receipt Source Fundraiser 03/05/22 Dustin Gatliff 207 Annaberg Ln Monroe, NC 28110 828-674-8840 d. Election Sum to Date $ 40.00 e. Description f. Date (mm/dd/yyyy) g. Fav Market Amount Metal Sign 03/05/2022 $ 30.00 Dog Chew Toy 03/05/2022 $ 10.00 a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Contributor c. Comments ® Individual Candidate 0 Parry E] PAC E] Referendum E] Other Receipt Source Fundraiser 03/05/22 Gabrielle Wheless 97 Market Point Dr, Apt 520 Greenville, SC 29607 832-561-7617 d. Election Sum to Date $ 160.00 e. Description £ hale (mm/dd/yyyy) g. Farr Market Amount Kanga Cooler 03/05/2022 $ 60.00 Willie Nelson Tickets 03/05/2022 $ 100.00 .. Total ge_ 250.00 o ages ' on line 17 of Detailed $ 1233.00 CRO -1510 NC State Board of Elections December 2007 Amendment In -Kind Contributions Pg z of s ❑ yea ® 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. Sandra Smith for Clerk Committee a. Full Name, Mailing Address & Phone (include city, sure. &zip) b. Type of Conmbmor e. Com ® Individual ❑ Candidate ❑ party ❑ PAC ❑ Referendum ❑ Other Receipt Source Fundraiser 03/05/22 Kelley Wheless 5312 Sagers Blvd The Colony, TX 75056 832-770-1145 d. Election Sum to Date $ 50.00 e. Description f. Date (mm/dd/yyyy) g. Fair Market Amount Wreath 03/05/2022 $ 25.00 Wreath 03/05/2022 $ 25.00 a. Full Name, Mailing Address & Phone (include city, share, &zip) b. Type of Contributor c. Comments ® Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source Fundraiser 03/05/22 Jacob Biddlecom 97 Market Point Dr, Apt 520 Greenville, SC 29607 704-773-7581 d. Election Sam to Date $ 250.00 e. Description £ Date (mm/dd/yyyy) g. Fair Market Amount Cornhole Boards 03/05/2022 $ 250.00 a Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Contnbmor c. Comments ® Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source Fundraiser 03/05/22 Kayla Brooks 4705 Nesbit Rd Monroe, NC 28112 704-320-0276 d. Election Sam to Date $ 70.00 e. Description f. Date (®/dd/yyW) g. Farr Market Amount Hair Products 03/05/2022 $ 70.00 $ oral only this Ps 370.00 0 o ages ' be on line 17 of Detailed 5 $ 1233.00 CRO -1510 NC State Board of Elections December 2007 Amendment In-Kind Contributions Pg 3 of s ❑ Yes ® No Use this form to report non-monetary contributions, donations, goods or services provided to the committee or m . -- Use CRO-1215 if In-Kind Contributions were or will be refunded within 7 days. Sandra Smith for Clerk Committee a. Full Name, Mailing Address & Phone (include city, state, &zip) b. Type of Contributor c. Comments ® Individual ❑ Candidate ❑ Parry ❑ PAC ❑ Referendum ❑ Other Receipt Source Fundraiser 03/05/22 Phil Young 4713 Magnolia Ridge Dr Waxhaw, NC 28173 704-618-1099 d. Election Sum to Date $ 250.00 e. Description f Dau (mn/dd/yyyy) g. Fair Market Amount BBQ 03/05/2022 $ 250.00 a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Contrrbuur c. Comments N Individual ❑ Candidate ❑ Parry ❑ PAC ❑ Referendum ❑ Other Receipt Source Fundraiser 03/05/22 Tommy Byrd 10319 Waxhaw Hwy Waxhaw, NC 28173 704-254-6679 d. Election Sum to Date $ 190.00 e. Description f. Dau (mm/dd/yyyy) g. Fav Market Amount Gamechanger Combole Bags 03/05/2022 $ 120.00 Stripers Comhole Bags 03/05/2022 $ 70.00 a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Contributor c. Comments N Individual ❑ Candidate ❑ Parry ❑ PAC ❑ Referendum ❑ Other Receipt Source Fundraiser 04/02/2022 Betty Goins 921 E Hwy 218 Monroe, NC 28110 704-753-1583 d. Election Sum to Date $ 20.00 e. Description f Dau (mm/dd/yyyy) g. Fav Market Amount Home Decor Sign 04/02/2022 $ 10.00 Home D6cor Sign 04/02/2022 $ 10.00 4. Total only ages _ _ $ 1233.00 on line 17 of Detailed CRO -1510 NC State Boatd of Elections December 2007 Amend In -Kind Contributions Pg 4 of 5 ❑ Yes ® No Use this form to report non -monetary contributions, donations, goods or services provided to the committee or tuna. Use CRO -1215 if In -Kind Contributions were or will be refunded within 7 days. Sandra Smith or Clerk Committee a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Contributor c. Comments ® Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source Fundraiser 04/02/2022 Mary Hasty 1702 Price Rd Indian Trail, NC 28079 704-242-3837 d. Election Sum to Date $ 35.00 e. Description £ Date (mm/dd/yyyy) g. Farr Market Amount Queen Ann Cake 04/02/2022 $ 35.00 a. Full Name, Mailing Address & Phone (include city, state. &zip) b. Type of Contributor c. Comments ® Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source Fundraiser 04/02/2022 Linda Witmore 4704 Nesbit Rd Monroe, NC 28112 704-7643149 d. Election Sum to Date $ 20.00 e. Description f. Dote (mrn/dd/yyyy) g. Fav Market Amount Garden Sign 04/02/2022 $ 20.00 a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Contributor c. Comrrceats ® Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source Fundraiser 04/02/2022 Donna Price 4510 Unionville Rd Monroe, NC 28110 704-506-7675 d. Election Sum to Date $ 20.00 e. Description £ Date (mm/dd/yyyy) g. Fair Market Amount Tin Sign 04/02/2022 $ 20.00 $ - — $ 4. Total only this Pa - S 75.00 o ages $ 1233.00 must be online l7 of DereOed Su CRO -151 o NC State Board of Elections December 2007 Amendment In -Kind Contributions Pg 5 of 5 ❑ Yes ® No Use this form to report non -monetary contributions, donations, goods or services provided to the committee or Use CRO -1215 if In -Kind Contributions were or will be refunded within 7 days. Sandra Smith for Clerk Committee a. Full Name, Meiling Address & Phoneb. (include city, state, &zip) Type of Contributor c. Coments E Individual El Candidate ❑ Party ❑ PAC E:]Referendum ❑ Other Receipt Source Fundraiser 04/02/2022 Terry Helms 127 Will Helms Rd Monroe, NC 28110 704-221-0469 d. Election Sum to Date $ 35.00 e. Description f Date (mm/dd/yyyy) g. Fair Market Amount Home Decor Sign 04/02/2022 $ 15.00 Home D&cor Sign 04/02/2022 $ 20.00 a. Full Name, Mailing Address & Phone (include city, state, &zip) b. Type of Contributor c. Comments ® Individual ❑ Candidate ❑ Part ❑ PAC ❑ Referendum ❑ Other Receipt Source Fundraiser 04/02/2022 Sherri Underwood 4704 Nesbit Rd Monroe, NC 28112 704219-8789 d Election Sum to Date $ 43.00 e. Description f. Date (mm/dd/yyyy) g. Fair Market Amount Tumbler 04/02/2022 $ 25.00 Earrings 04/02/2022 $ 8.00 Key Chain 04/02/2022 $ 10.00 a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Contributor c. Comments ❑ Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum ❑ Other Receipt Source d. Election Sam to Date $ e. Description f. Date (mnVdd/yyyy) g. Fair Market Amount $ 4. otal only this Page $ 78.00 .. „o _ o,: . ages $ 1233.00 be on line 17 of Detailed SummA CRO -1510 NC State Board of Elections December 2007 NORTH 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: 04/30/2022 • Name of lending institution (source): Personal Funds • Amount of loan: $2173.03 • Description (if in-kind loan): $173.03 media purchases • Names of all parties responsible for payment of loan (guarantors): Sandra Smith • Period of loan: n/a • Rate of interest of loan: n/a • Security pledged for loan: n/a Sandra W Smith acknowledge that all of the information (Person lending money to committee) provided complete, true,)an( accurate. I further understand I may not forgive a loan that ha n outstanding lo nce-W any source. (�,lG 05-10-2022 Signature of Lender Date Signed -4 05-10-2022 Signature of Treasurer of Committee Date Signed CRO -6/00 Lain Proceeds Statement