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Thomas,Jonathon_2021-Year-endAmendment Disclosure Report Cover I ❑ Yes ❑ No Use'this form for general report and committee information, must be signed and submitted along with other detailed forms. Flo not use this form to update information 1. Committee Information a. Full Name c. ID Number Thomas for Union County JRT 72221 b. Mailing Address (include City, State and Zip Code) d. Date Filed 2001 Belle Forest Court 1/10/2022 Waxhax NC 28173 e. Phone Number 704-771-4940 2. Report Year 3. Period Start Date (mm/dd/yy) 4. Period End Date 5. Treasurer Full Name mm/dd Patrick 2021 07/22/2021 12/31/2021 Harrison 6. Type of Committee Check One 9. Type of Report check on one twe o re ort rom one category) ® Candidate Campaign ❑ Party Municipal State/County Referendum ❑ Organizational ❑ Organizational ❑ Organizational ❑ PAC ❑ Referendum Independent ❑ Joint Fundraiser ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Expenditure ❑ Legal Expense Fund ❑ Pre-primary - ❑ Pre-election ❑ First ❑ Second ❑ Final ❑ Supplemental Final 7. a of Fund (trapplicable, check one) ❑ 'Booster Fond" ❑ Building Fund ❑ Pre -runoff ❑ Third ❑ Annual Semi-annual ❑ Fourth ❑ Special ❑ Mid Year Semi-annual ❑ Other: ❑ Year End ❑ Mid Year 10. Special Report Name ❑ Final ❑ Special ® Year End ❑ Final ❑ Special 8. Number of Fundraisers this Report 11. Account Information 11. Account Information a. Financial Institution Full Name a. Financial Institution Full Name BB&T/T7uist b. Purpose c. Account Code b. Purpose c. Account Code Checking JT22 UNION COUNTY CAMPAIGN FINANCE d. Period Begin Balance d. Period Begin Balance $ 0 $ JAN 18 2022 CERTIFICATION �EF j� I certify that the Committee or Fund is in compliance with all applicable provisions of rc eI2 A, , & 22D -22M of Chapter 163 of the NC General Statutes and that no funds are commingled with pro ti ' or o It r non -disclosed funds. I further certify that this report is complete, true and correct and that I have been trained by d f Elections. Patrick Harrison e- 01/10/2022 Printed Name of Signer SignaturefAp' e Treasurer Date FOR OFFICE USE ONLY Delivery Method Date Received: T Employee: ❑ Normal Mail ❑ rstered Mail Date Postmarked: Employee: Hand Delivered ❑ Electronically Filed Date Scanned: 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 ❑ Yes ❑ No I lse this form to summarize all disclosure reoortine forms and to total monetary information. 1. Committee Full Name and Fund if applicable) 2. Type of Report 3. ID Number Thomas for Union County Year End JRT72221 Start of Election Cycle: January 1, 2021 'total this Reporting Period Total Election Cycle Cy 4) Cash on Hand at Start $ 0 $ 0 RECEIPTS - 5) Aggregated Contributions from Individuals 6) Contributions from Individuals 7) Contributions from Political Party Committees 8) Contributions from Other Political Committees 9) Loan Proceeds 10) Refunds/Reimbursements To the Committee 11) Other Receipt Sources Ila) Interest on Bank Accounts llb) Contributions from Not -for -Profit Organizations lie) Outside Sources of Income lld) Legal Expense Fund - Other Sources 11 e) Exempt Purchase Price Sales IRW„ (CRO -1205) (CRO -1210) (CRO -1220) (CRO -1230) (CRO -1410) (CRO -1240) — (CRO -1250) (CRO -1250) (CRO -1250) (CRO -1270) (CRO -1265) $ $ $ 100.00 $ $ $ $ 1064.06 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10, Ila, Ilb, Ile, 11dand Ile) $ 1,164.06 $ EXPENDITURES 13) Disbursements 13a) Operating Expenditures 13b) Contributions to Candidates/Political Committees 13c) Coordinated Party Expenditures 14) Aggregated Non -Media Expenditures 15) Loan Repayments 16) Refunds/Reimbursements From the Committee 17) In -Kind Contributions (CRO -1310) (CRO -1310) (CRO -1310) (CRO -1315) - (CRO -1420) (CRO -1320) (CRO -1510) $ 178.54 $ $ $ $ $ $ $ $ $ $ $ $ $ 18) TOTAL EXPENDITURES (Add lines 13a,13b,13c, 14,15,16 and 17) $ 178.54 $ 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18) $ 985.52 $ 985.52 ADDITIONAL INFORMATION 20) Non -Monetary Gifts Given to Other Committees 21) Outstanding Loans (incl. ones from other campaigns) 22) Debts and Obligations owed By the Committee 23) Debts and Obligations owed To the Committee 24) Account Transfers Within the Committee 25) Administrative Support 26) Forgiven Loans 27) 48 -Hour Notice Reports Sum 28) Contributions to be Refunded (CRO -1330) (CRO -1430) (CRO -1610) (CRO -1620) (CRO -1720) (CRO -1710) (CRO -1440) (CRO -2220) (CRO -1215) $ 661 $ $ $ $ $ $ $ C PAIGN FINANCE $ $ IAN 1 202? $ CRO -1100 NC State Board of Elections H C V t v b$nst 2008 Amendment Contributions from Individuals Pg I or lnri ❑ Yes ❑ No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Full Name and Fund if applicable) 2. ID Number Thomas for Union County JRT72221 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession it. Comments Retired Elaine K. Stevens 501 Todd Circle Wingate NC 28174 c. Employer's Name/Specific Field c. Election Sum to Date $ 100.00 f. Prior g. Account Code h. Form of Payment i. In-IGnd Description j. Date (mmldd/yyyy) k. Amount ❑ Check 11/16/2021 $ 100.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Fall Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments c. Employer's Name/Specific Field e. Election Sum to Date $ f. Prior g. Account Code h. Form of Payment i.In-Kind Description j. Date (mm/dd/yyyy) It. Amount ❑ $ ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession it. Comments c. Employer's Name/Specific Field e. Election Sum to Date f. Prior I g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/ddlyyyy) k. Amount ❑ $ ❑ $ ❑ $ 4. Total only this Page $ 100.00 5. Total of ALL CRO -1210 Pages (This line inusf be on line 6 of Detailed Summary Page CRO -1100) UNION COUNTY 100.00 CAMPAIGN CRO -1210 NC State Board of Elections JAN 18 April 2007 7.022 RECEIT-77" Contributions from Other Political Committees Pg Use this form to report contributions from other candidate, referendum or PAC committees I Amendment of 1 I ❑ Yes ❑ No 1. Committee Full Name and Fund if applicable) 2.11) Number Thomas for Union County JRT72221 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Committee d. Comments ® Candidate ❑ PAC ❑ Referendum Richard Helms 1212 Rosehill Drive Waxhaw NC 28173 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 1,064.06 f. Account Code g. Form of Payment h.In-Kind Description I. Date (mm/dd/yyyy) j. Amount JT22 Check 08/04/2021 $ 1,064.06 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Committee d. Comments ❑ Candidate ❑ PAC ❑ Referendum c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ f. Account Code g. Form of Payment h. In -Kind Description i. Date (mmlddlyyyy) j. Amount $ $ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Type of Committee d. Comments ❑ Candidate ❑ PAC ❑ Referendum c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ f. Account Code g. Form of Payment h. In-Kiad Description i. Date (mm/dd/yyyy) j. Amount $ $ U CAM ION COUNTY AIGN FINANCE $ 4. Total only this Page $ 1,064.06 5. Total of ALL CRO -1230 Pages (This line must be on line 8 of Demiled Sutnmary Page CRO -1100) RFrFIVFD $ 1,064.06 CRO -1230 NC State Board of Elections April 2007 1 Amendment Disbursements Pg of ❑ Yes ❑ No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated ariv ex enditures. 1. Committee Full Name and Fund if applicable) 2. II) Number Thomas for Union County JRT72221 3. Type of Disbursement Please use separate CRO -1310 formy for each type of Disbursement. ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments NameTagWizard Florida 904-396-2291 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 1,136.21 L Account Code g. Form of Payment h. Purpose Code i. Date (mm/ddlyyyy) j. Amount k. Required Remarks JT22 Electronic O 10/28/2021 $27.85 Name Tag 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, stat & zip) b. Coordinated Committee Name d. Comments Google LLC 1600 Amphitheatre Pkwy Mountain View Ca. 94043 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 1,134.49 E Account Code I g. Form of Payment h. Purpose Code i. Date (mmldd/yyyy) j. Amount k. Required Remarks JT22 Electronic O 10/04/2021 $1.72 Subscrition Domain Name $ 4. Payee Information Add Remove a. Full Name, Mailing Address & Phone include city, state & zip) b. Coordinated Committee Name d. Comments HostGator Houston Tx 888-514-2867 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 1,128.49 L Account Code g. Form of Payment h. Purpose Code L Date (mm/dd/yyyy) j j. Amount k. Required Remarks JT22 Electronic O 10/12/2021 $6.00 Website Hosting $ U �Z N 5. Total only this Pae $ 35.57 z o 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Derailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 131, of Detailed Summary Page CRO -1100 if Contrib to Candidates/Politicat Comm) (Thls line goes 1n line 13c ojDelailed Summary Page CRO -1700 if Coordinated Party Expenditures) OO z z (D $ 178.54 O Z 5 ao P- 7. Purpose Codes(List detailed expenditure code in above A* -Media B* - Printing C* - Fundraising E - Salaries F* - Equipment G - Political Party I - Postage J - Penalties K* - Office Expenses O* - Other * Codes require detailed explanation in required remarks field k D - To Another Candidate H* - Holding Public Office Expenses Q* - Donation to Legal Expense Fund CRO -1310 NC State Board of Elections December 2009 Amendment Disbursements Pg of ❑ Yes ❑ No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political cnmmittees and coordinated narty expenditures. 1. Committee Full Name and Fund if a licable 2. ED Number Thomas for Union County JRT72221 3. Type of Disbursement lease use separate CRO -1310 forms for each type of Disbursement. ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state & zip) b. Coordinated Committee Name d. Comments Google LLC 1600 Amphithatre Pkwy Mountain View Ca. 94043 c. Level Registered (Specify) ❑ Federal ® County: ❑ state ❑ Municipality: e. Election Sum to Date $ 1,110.76 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks JT22 Electronic O 11/02/2021 $13.28 Subscrition Domain Name JT22 Electronic O 11/02/2021 $4.45 Domain Name 4. Payee Information ❑ Add El Remove a. Full Name, Mailing Address & Phone include city, state, & zip) b. Coordinated Committee Name d. Comments HostGator Houston Tx 888-514-2867 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 1,104.76 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/ddlyyyy) J. Amount k. Required Remarks JT22 Electronic O 11/12/2021 $6.00 Website Hosting 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state & zip) b. Coordinated Committee Name d. Comments Paper and Inc Printing 740 Stallings Road Matthews NC 28104 704-821-4500 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 1,010.82 E Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) I j. Amount Jr. Required Remarks JT22 Debit Card B 11/18/2021 $93.94 Business Cards $ 117.67 5. Total only this Pae 6. Total of ALL CRO -1310 Pages (This lime goes in line 13a ofDelailed Summary Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Detailed Summary Page CRO-11001fContrib to Candidates/Political Comm) (This lingoes in line 13c of Detailed Summary Page CRO -11001] CoordinatedPany Expenditures) z z N $ 178.54 00 U (Z9 z — 1' 1' ii W 7. Purpose Codes(List detailed expenditure code in h, above — ° Q A* - Media B* - Printing C* - Fundraising E - Salaries F* - Equipment G - Political Party I - Postage J - Penalties K* - Office Expenses O* - Other * Codes require detailed explanation in required remarks field k D - To Another Candidate —) <C H* - Holding Public Office Expen`s4 Q* - Donation to Legal Expense Fund cc CRO -1310 NC State Board of Elections December 2009 Amendment Disbursements Pg of ❑ Yes ❑ No .Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated Dartv expenditures. 1. Committee Full Name and Fund if applicable) 2. II) Number Thomas for Union County IRT72221 3. Type of Disbursement 6ftm use separate CRO -1310 forms for each e of Disbursement. ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, state & zip) b. Coordinated Committee Name d. Comments HostGator Houston Tx 888-514-2867 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 1,004.82 1. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount it. Required Remarks JT22 Electronic O 12/13/2021 $6.00 Website Hosting $ 4. Payee Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone include city, stat & zip) b. Coordinated Committee Name d. Comments Google LLC 100 Amphitheatre Pkwy Mountain View Ca. 94043 c. Level Registered (Specify) ❑ Federal ® County: ❑ State ❑ Municipality: e. Election Sum to Date $ 982.52 f. Account Code g. Form of Payment It, Purpose Code i. Date (mmldd/yyyy) j. Amount k. Required Remarks JT22 Electronic O 12/02/2021 $13.30 Domain Name JT22 Electronic O 12/03/2021 $6.00 Domain Name 4. Payee Information ❑ Add ❑ Remove 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 g. Form of Payment it. Purpose Code i. Date (mmlddlyyyy) J. Amount k. Required Remarks $ $ w 1J 5. Total only this Pae $ 15.30 z c. 6. Total of ALL CRO -1310 Pages (This line goes to line 13a of Detailed Summary Page CRO -1100 if Operating F_Venser) (This line goes in One 131, ofDemlled Summary Page CRO -1100 ifCorarib to Candidates/PoIldcal Comm) (This line goes in One 13c of Detniled Summary Page CRO -1100 ifCoordlnated Parry Expenditures) Z o $ 178.54 O Z O'D ZZ O zz Q W V 7. Purpose Codes(List detailed expenditure code in h. above z LU A* - Media B* - Printing C* - Fundraising E - Salaries F* - Equipment G - Political Party I - Postage J - Penalties K* - Office Expenses O* - Other * Codes require detailed explanation in required remarks Geld k D - To Another Candidate C� H* - Holding Public Office Expenses Q* - Donation to Legal Expense Fund CRO -1310 NC State Board of Elections December 2009