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Smith,Sandra_2022-Final-qtrAmendment Disclosure Report Cover ❑ Yea ® No Use this form for general report and committee information, must be signed and submitted along with o er eth d ta-Me-d o—nus. 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 07/11/2022 e. Phone Number 704-291-0806 2021 05/01/22 06/30/22 Sandra B Norris ® Candidate Campaign ❑ Party Muhicipal statecoumy Referendum ❑ PAC ❑ Referendum ❑ organizational ® Organizational ❑ Organizational Independent Joint Fundraiser Expenditure C] Joint ❑ Ex Thirty-five Y five da 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 ❑ Special a. Financial Institution Full Name a. Financial Institution Full Name American Bank b. Purpose c. Account Code Campaign I - - 2 JUL 202219, J U L t �I. d. Period Begin Balance 'od Begin Balance S 1068.70 RECEIVEDRp,,,�,-r $_ CERTIFICATION I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B, & 2213-22M of Chapter 163 (it 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 Sta Board of Elections. Sandra B Norris _K}��r_ 07/11/2022 Printed Name of Signer Signature of pointed Treasurer Date FOR OFFICE USE ONLY Delivery Method Date Received: Employee: ❑ Normal Mail egistercd Mail Date Postmarked: Employee: 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 �eDd s No Use this form to summarize all disclosure reporting forms and to total monetary information. Sandra Smith For ClCommittee Organization 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) $ 1068.70 $ 0 $ 0 $ 3429.70 6) Contributions from Individuals (CRO -1210) $ 0 $ 4017.10 7) Contributions from Political Patty Committees (CRO -1220) $ 0 $ 0 8) Contributions from Other Political Committees (CRO -1230) $ 0 S 0 9) Loan Proceeds (CRO -1410) S 181.30 $ 3722.11 10) Refunds/Reimbursements To the Committee (CRO -1240) $ 0 $ 0 11) Other Receipt Sources Ila) Interest on Bank Accounts (CRO -1250) $ 0 $ 0 l lb) Contributions from Not -for -Profit Organizations (CRO -1250) $ 0 $ 0 11c) Outside Sources of Income (CRO -1250) $ 0 $ 0 l ld) Legal Expense Fund— Other Sources (CRO -1270) $ 0 $ 0 11 e) Exempt Purchase Price Sales (CRO -1265) $ 0 S 0 12) 13) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10, Ila, 1 Ib, lit, 11d and Ile) Disbursements $ 1250.00 S 11168.91 13a) Operating Expenditures (CRO -1310) $ 1250.00 $ 9935.91 13b) Contributions to Candidatea/Political Committees (CRO -1310) $ 0 S 0 13c) Coordinated Party Expenditures (CRO -1310) S 0 $ 0 14) Aggregated Non -Media Expenditures (CRO -1315) S 0 S 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 $ 1233.00 18) TOTAL EXPENDITURES (Add Goes 13a, 13b, 13c, 14,15,16 and 17) $ 1250.00 $ 11168.91 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18) $ $ 0 0 $ 0 20) Non -Monetary Gifts Given to Other Committees (CRO -1330) 21) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) $ $ $ 3722.11 0 0 7 22) Debts and Obligations owed By the Committee (CRO -1610) 23) Debts and Obligations owed To the Committee (CRO -1620) 24) Account Transfers Within the Committee (CRO -1720) $ 0 25) Administrative Support UNION COUNTY (CRO -1710) S 0 $ 0 26) 27) 28) Forgiven Loans CAMPAIGN FINANCE 48 -Hour Notice Reports Sum JUL 12 2022 Contributions to be Refunded (CRO -1440) (CRO -2220) (CRO -1215) $ 3722.11 $ 3722.11 S 0 $ 0 $ 0 $ 0 CRO -1100 1 '�IW9tatd96a?ft? Iections August 2008 Amendment Disbursements Pg 1 of 1 ❑ Yes ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate pToTittcal committees and coordinated party expenditures. CRO -1310 NC State Board of Elections December 2009 Sandra Smith or Clerk Committee ® 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 WIXE Radio c. Level Registered (Specify) Federal ® County: El State E] Municipality: e. Election Sum to Date $ 531.00 f. Account Code g. Form of Payment It. Purpose Code i. Date (mm/dd/yyyy) j. Amount It. Required Remarks 1 Credit Card A 05/13/2022 $225.00 Radio Advertise ment a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Coordinated Committee Name d. Comments Logo's Marketing c- Level Registered (Specify) E] Federal ® County: E] State ❑ Municipality: e. Election Sum to Date $ 625.00 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount L Required Remarks I Credit Card A 05/17/2022 $625.00 Handout Cards For Polls . a a. Full Name, Mailing Address & Phone (include city, state, & rip) b. Coordinated Committee Name d Comments Rhonda H Marsh Accountant 1807 Morgan Mill Rd Monroe, NC 28110 704-289-5155 a Level Registered (specify) ❑ Federal ® county: ❑ State ❑ Municipality: e. Election Sum to Date $ 750.00 f Account Code I g. Form of Payment IL Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Requued Remarks I Check K 05/18/2022 $400.00 Accounting Fees $ 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 Contrib to Candidates/Political Comm) This line goes in line 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures) 1250.00 $ 1250'00 m -Media - Printing sag D - To Anot er Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses 1 - Postage 1 - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund 0* - Other CRO -1310 NC State Board of Elections December 2009 Forgiven Loans pg Use this form to report any loan which has been forgiven by the lender. A Forgiven loan statement (CRO -6200) must accompany each forgiven loan. Amendment of 1 1] Yes ® No Sandra Smith for Clerk Committee a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Com Personal Funds Sandra Smith 4706 Nesbit Rd Monroe, NC 28112 704-2924086 c. Original loan hate (mm/dd/yyyy) f. Election Sum to Date 12/10/2021 $ 1367.78 d. Original Loan Amount g. Date (mm/dd/yyyy) $ 1367.78 06/30/2022 e. Remaining Loan Balance h. Forgiven Amount $ 1367.78 $ 1367.78 a. Full Name. Mailing Addtesa & Phone (include city, state, & zip) b. Comments Personal Funds Sandra Smith 4706 Nesbit Rd Monroe, NC 28112 704-292-4086 c. Original loan Date (nun/dd/yyyy) f Election Som to Date 04/30/2022 $ 3540.81 d. Original Loan Amount g. Date (mm/ddlyyyy) $ 2173.03 06/30/2022 e. Remaining loan Balance It. Forgiven Amount $ 2173.03 $ 2173.03 a. Full Name, Mailing Address & Phone (include city, sate, & zip) b. Comments Personal Funds Sandra Smith 4706 Nesbit Rd Monroe, NC 28110 704-292-4086 4. Total only this Page$ 5. Total of ALL CRO_ 1440 Pages (This hoe must be on line 26 of Qeudled Summary Page, ,RO-1100) . - c. Original loan Date (mm/dd/yyyy) f Election Sum to Date 05/16/2022 11 3722.11 it. Original Loan Amount g. Date (mm/ddryyyy) $ 181.30 06/30/2022 e. Remaining loan Balance It. Forgiven Amount $ 181.30 $ 181.30 3722.11 $ 3722.11 The lender information should contain the same information as supplied under the original loan proceed. UNION COUtdTY CRO -1440 1 ! I - NC State Board of Elections December 2007 JUL 12 2022 RECEIVEC V© 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: 05/16/2021 • Name of lending institution (source): • Amount of loan: 181.30 • Description (if in-kind loan): • Names of all parties responsible for payment of loan (guarantors): Sandra Smith • 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) provide complete, true, a accur e. I further understand I may not forgive a loan that hnn outstanding bal ce t source. 06-30-2022 Signature of Lender Date Signed 06-30-2022 UNION U Signature of Treasurer of Committee CAMPAIGN FINANCE Date Signed CRO-6100 Locus Proceeds Statement ) 2 JUL 2022 RECEIVED NORTH CAROLINA STATE BOARD OF ELECTIONS Forgiven Loan Statement This form is used to report a ban that has been forgiven by the lender. The lender's signature is required on this form and it must accompany the next filed report. This Statement is to be filed with the Election Board where the committee's reports are filed. Name of Lender: Sandra W Smith Committee receiving loan: Sandra Smith for Clerk Committee Date of loan: 12/10/21, 04/30/22, 05/16/22 Amount of original loan: 1367.78,2173.03, 181.30 *Amount of loan to be for iven:$3,722.11 Sandra W Smith , do not wish to be reimbursed for the amount of the loan indicated above* and will consider the amount loaned a contribution to the committee. I understand and confirm no other parties are responsible for payment of this loan. I may not forgive a loan for which there is an outstanding balance owed to any source. Signature of Committee rer UNION COUNTY CP° IP41GN FINANCE CRO -6200 Forgiven loan Statement i W IL L.