Williams,David_2019-YearendAmendment
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.
Do not use this fore to update information
1. Committee Information
a. Full Name
c. ID Number
Elect David Williams
M1MVR6
TV
b. Mailing Address (include City, State and Zip Code)
CAMPAIGN FINANCE
d. Date Filed
P.O. Box 2276
Indian Trail, NC 28079
JAN 3 0 2020
01/30/2020
e. Phone Number
RECEIVED
980-328-4408
2. Report Year
3. Period Start Date (mm/ddtyy)
. Period End Date
(mm2019
5. Treasurer Full Name
07,10112019
12/31/2019
David H. Williams
6. Type of Committee Check One
9. Type
of Report check only one t4jpe of report rom one category)
® Candidate Campaign ❑ Party
Municipal
State4ounty
Referendum
❑ PAC ❑ Referendum
❑
Organizational
❑ Organizational
❑ Organizational
Independent ❑ Joint Fundraiser
❑ Expenditure
❑
Thirty-five day
Quarterly
❑ Pre -referendum
Legal Gxpense Fund
❑
❑
Pre-primary
Pre-election
❑ First
❑ Second
❑ Final
❑ Supplemental Final
7. Type of Fund (if applicable. check one)
❑ "Booster Fund"
❑ 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
® Yew End
❑ Final
❑ Special
8. Number of Fundraisers this Report
None
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
BB&T
b. Purpose
c. Account Code
b. Purpose
c. Account Code
Campaign
Donations
Z
d. Period Begin Balance
it. Period Begin Balance
and
$ 0.00
$
Expenditures
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 1 have been trained
by the NC Stat Board of EleFtions.
David H. Williams
01/30/2020
Printed Name of Signer
la riotA
Si�gnmure o"�Ap i Treasurer
Date
FOR OFFICE USE ONLY
Date Received: 3 l]
Employee: Delivery Method
ElNormal Mail
Date Postmarked:
Registered Mail
Employee:
Hand Delivered
Date Scanned:
{j�u��j
Employee: Electronically Filed
❑ Signer has not received
Date Data Entered:
Employee:
mandatory training
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.
/wn- /aaa Nr Ctatr RnarA of Flrrtinnc Auooct ?nnR
Amendment
Detailed Summary ❑ ves ® No
Use this form to summarize all disclosure reoortina forms and to total monetary information.
1. Committee Full Name and Fund if applicable)
2. Tvne
of Report
3. ID Number
Elect David Williams
Year
EndSemi-annualVIAIVR6
Start of Election Cycle: January 1, 21W -7
Total this
Reporting Period
Total this
Election Cycle
4)
Cash on Hand at Start
$
$
5)
6)
7)
8)
9)
10)
11)
Aggregated Contributions from Individuals
Contributions from Individuals
Contributions from Political Party Committees
Contributions from Other Political Committees
Loan Proceeds
Refunds/Reimbursements To the Committee
Other Receipt Sources
I la) Interest on Bank Accounts
1lb) Contributions from Nat -for -Profit Organizations
Ile) Outside Sources of Income
Ild) Legal Expense Fund—Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1105)
(CRO -1110)
(CRO -1220)
(CRO -1130)
(CRa1410)
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
$
$
$ 936.85
$
936.85
$
$
$ 184.34
$
184.34
$
$
$
$
$ $
$ $
$ $
$ $
j $ $
12)
TOTAL RECEIPTS (Add liesS,6, 7,8,9, 10, Ila, l lb, llc, Ildand Ile)
$
1,121.19
$
1,121.19
FXPK,
13)
14)
15)
16)
17)
Disbursements
l3ai Operating Expenditures
13b) Contributions to Candidates/Political Committees
13c) Coordinated Party Expenditures
Aggregated Non -Media Expenditures
Loan Repayments
Refunds/Reimbursements From the Committee
In -Kind Contributions
(CRO -1310)
(CRO -1310)
(CRO -1310)
(CRO -1315)
(CRO -1420)
(CRO -1310)
(CRO -1510)
$
$
$ $
$ $
$ $
$ $
$ $
$ 136.85 $
136.85
18)
TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$
136.85
$
136.85
19)
Cash on Hand at End (Add lies 4 and 12 together, then sabtracl line 18)
$
984.34
$
984.34
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 CodMilUd COUNTY
Administrative Support CAMPAIGN FINANCE(CROano)
Forgiven Loans JAN 3 O 2020
48 -Hour Notice Reports Sum RECEIVED
Contributions to be Refunded
(CRO -1330)
(CRO -1430)
(CRO -1610)
(CRO -1610)
(CRO -1710)
(CRO -1440)
(CRO -2220)
(CRO -1215)
$
t
$
$
$
$
$ $
$ $
$ $
$ $
CRO -1100 NC State Board of Elections August 2008
Amendment
Contributions from Individuals Pg I of I ❑ res ® No
Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used
L Committee Full Name and Fund if applicable)
2. to Number
Elect David Williams
MJM V R6
3. Coutributor Information ® Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
It. Job Title/Profession
d. Comments
Attorney
David Williams
1014 Exodus Court
Monroe, NC 28110
c. Employer's Name/Specific Field
Self
Legal Services
e. Election Sum to Date
$ 536.85
f. Prior
g. Account Code
It. Form of Payment
i. to -Kind Description
j. Date (mm/dd/yyyy)
it. Amount
❑
Z
electronic
12/24/2019
$ 400.00
❑
Z
in-kind
postage
12/272019
$ 49.50
❑
Z
in-kind
website hosting
12/27/2019
$ 87.35
3. Contributor Information ® Add ❑ Remove
a.Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
Retired
Elizabeth Williams
6623 Mimosa Lane
Dallas, TX 75230
c. Employer's Name/Specific Field
N/A
e. Election Sum to Date
$ 400.00
E Prior
g. Account Code
it. Form of Payment
i. In -Kind Description
j. Date (mm/dd/yyyy)
k. Amount
❑
Z
check
12/30/2019
$ 400.00
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, stet N COUNTY
JAN 30 2020
RECEIVEDe.
b. Job'1'itlr/Profession
d. Comments
c. Employer's Name/Specific Field
Election Sum to Date
$
E Prior
g. Account Code
Is. Form of Payment
i. In -Kind Description
j. Date (mm/dd/yy")
it. Amount
❑
$
❑
$
❑
$
4. Total only this Page $ 936.85
5. Total of ALL CRO -1210 Pages
$ 936.85
(This line must be on tine 6 of Detailed Summary Page CRO -1100)
CRO -1210 NC State Board of I lections April 2007
Contributions from Other Political Committees Pg
Use this form to report contributions from other candidate, referendum or PAC committees
Amendment
of I ❑ 1 es ® Nc
1. Committee Full Name and Fund if applicable)
2. ID Number
Elect David Williams
MJMVR6
3. Contributor Information ® Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Type of Committee
d. Comments
® Candidate ❑ PAC
❑ Referendum
Travis Wilson for Commissioner
7925 Jaars Road
Waxhaw, NC 28173
c. Level Registered (Specify)
❑ Federal ® County:
❑ State Municipality:
e. Election Sum to Date
$ 184.34
f. Account Code
g. Form of Payment
h. In -Kind Description
1. Date (mm/dd/yyyy)
j. Amount
Z
check
12/30/2019
$ 184.34
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 (mm/ddlyyyy)
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
CAMPAIGN FINANCE
JAN 3 0 2020
RECEIVED
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State Municipality:
e. Election Sum to Date
1
$
f. Account Code
g. Form of Payment
h. In -Kind Description
I. Date (mm/dd/yyyy)
j. Amount
$
4. Total only this Page $ 184.34
5. Total of ALL CRO -1230 Pages $ 184.34
(This Use nuzvr be on One 8 ojDeraUed Summary Page CRO -1100)
CRO -1230 NC State Board of Elections April 2007
Amendment
In -Kind Contributions Pg 1 of ❑ Yes ® 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.
1. Committee Full Name and Fund if applicable) 2. ID Number
Elect David Williams MJMVR6
3. Contributor Information Z Add Remove
a. Full Name, Mailing Address & Phone
(include city, state, & tip)
b. Type of Contributor
C. Comments
❑ Individual
® Candidate
❑ Party
❑ PAC
❑ Referendum
❑ Other Receipt Source
David Williams
1014 Exodus Court
Monroe, NC 28110
d. Election Sum to Date
$ 136.85
e. Description
E Date (mm/dd/yyyy)
g. Fair Market Amount
Postage
12/27/2019
$ 49.50
Website hosting
12/27/2019
$ 87.35
3. Contributor Information Add Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Type of Contributor
e. Comments
❑ Individual
❑ Candidate
❑ Party
❑ PAC
❑ Referendum
❑ Other Receipt Source
d. Election Sum to Date
$
e. Description
f. Date (mm/dd/yyyy)
g. Fair Market Amount
3. Contributor Information Add Remove
a. Full Name, Mailing Address & Phone
(include city, state,&zi NION COUNTY
b. Type of Contributor
c. Comments
❑ Individual
❑ Candidate
El PC
E] PAC
❑ Referendum
❑ Other Receipt Source
JAN 3 0 2020
RECEIVED
d. Election Sum to Date
$
e. Description
E Date (mm/dd/yyyy)
g. Fair Market Amount
$
4. Total only this Pae $ 136.85
5. Total of ALL CRO -1510 Pages $ 136.85
(This fine nuest he online 17 of Detailed Sumnmry Page CRO -1100)
CRO -/510 SC State Board of Elections December 2007