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Williams,David_2020-1st-qtrAmendment Disclosure Report Cover ❑ Yea ® No Use this form for general report and committee information, must be signed and submitted along with other detailed forms. Do not use this form to update information 1. Committee Information a. Full Name e. ID Number Elect David Williams MJMVR6 UNION COUNTY It. Mailing Address (include City, State and Zip Code). CAMPAIGN FINANCE it. Date Filed P.O. Box 2276 FEB 2 4 2020 02/24/2020 Indian Trail, NC 28079 e.Phone Number RECEIVED 980-328-4408 2. Report Year 3. Period Start Date pnm/ddtyy) 4. Period End Date 5. Treasurer Full Name (mm/dd/yy) David H. Williams 2020 01/01/2020 02/15/2020 6. Type of Committee (Check One) 9. Type of Report check only one type ofre ort rom one category) ® Candidate Campaign ❑ Party Municipal State/County Referendum ❑ PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational Independent ❑ Joint Fundraiser ❑ Expenditure ❑ Thirty-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑ Pre-primary ❑ Pre-election ® First ❑ Second ❑ Final ❑ Supplemental Final 7. Type of Fund flfapplicable, 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 Reort Name ❑ Final ❑ special ❑ Year End ❑ Final ❑ Special 8. Number of Fundraisers this Report p 11. Account Information 11. Account Information a. Financial Institution Full Name a. Financial Institution Full Name BB&T b. Purpose c. Account Code It. Purpose c. Account Code Campaign Z Donations it. Period Begin Balance d. Period Begin Balance and Expenditures $ 984.34 $ CERTIFICATION I certify that the Committee or Fund is in with all applicable provisions of Article 22A, 22B, & 22D -22M of Chapter 163 of the NC Genera) 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 NCtAonBnAq ar f ec ons. - David H. Williams i,Yl'V 02/24/2020 Printed Name of Signer Signature of Appointed Treasurer Date FOR OFFICE USE ONLY - Delivery Method Date Received: Employee: Employee: ❑ Normal Mail [� Registered Mail Date Postmarked: Employee: J❑�f 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. rnn-Ififin NC State. Rnard nfFlentinn¢ A...mt 9nnR Amendment Detailed Summary ❑ Yes ® No T tse this form to summarize all disclnsure renortine forms and to total monetary information. --- ----- ----- -- --------- 1. Committee Full Name(and 'Fund 'if applicable) 2. Type'of Report 3. ID Number Elect David Williams First Quarter Plus MJMVR6 Start of Election Cycle: January 1, 2017 Total riod Re orcin Period Total this Election Cycle 4) Cash on Hand at Start 1 $ 984.34 $ 0.00 5) 6) 7) Aggregated Contributions from Individuals - -- -- _--...--.. ----- Contributions from Individuals Contributions from Political Party Committees (CRO -1205) - ----- (CRO -1210) (CRO -1220) $ $ $ 6,440.40 $ $ $ 7,377.25 8) 9) 10) 11) --.. - Contributions from Other Political Committees Loan Proceeds Refunds/Reimbursements To the Committee - -. Other Receipt Sources Ila) Interest on Bank Accounts lib) Contributions from Not -for -Profit Organizations - (CRO -1230) (CRO -1410) (CRO -1240) (CRO -1250) (CRO -1250) $ $ $ $ $ $ 184.34 $ $ $ $ Ile) Outside Sources of Income 11d) Legal Expense Fund Other Sources I l e) Exempt Purchase Price Sales (CRO -1250) (CRO -1270) (CRO -1265) $ $ $ $ $ $ 12) TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9,10, Ila, 116, 11c, 11d aid Ile) $ 6,440.40 $ 7,561.59 EXPENDIT 13) Disbursements 13a) Operating Expenditures 13b) Contributions to Candidates/Political Committees 13c) Coordinated Party Expenditures 14) Aggregated Non Media Expenditures (CRO -1310) (CRO -1310) (CRO -1310) (CRO -1315) !i $ 4,033.43 $ 4,033.43 $ $ $ $ $ $ 15) 16) 17) Loan Repayments Refunds/Reimbursements From the Committee In -Kind Contributions (CRO -1420) ....-- (CRO -1320) (CRO -1510) $ $ $ $ $ $ 136.85 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ 4,033.43 $ 4,170.28 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18) $ 3,391.31 $ 3,391.31 ADDITIONAL INFORMATION 20) Non -Monetary Gifts Given to Other Committees _ 21) Outstanding Loans (incl. ones from other campaigns) . (CRO -1330) -- (CRO -1430) $ $ 22) Debts and Obligations owed By the Committee (CRO -1610) $ 23) _. - -- — ----- .-... Debts and Obligations owed To the Committee (CRO 1620) $ 24) 25) 26) 27) 28) --- ..... -- -- Account Transfers Within the Committee Administrative Support - - - - Forgiven Loans 48 -Hour Notice Reports Sum Contributions to be Refunded (CRO -1720) (CRO -1710) (CRO -1440) (CRO -2220) (CRO -1215) $ COUNTY FINANUL $ UN114 $ CAMN $ F R 2 4 2020 1 $ CRO -1100 NC State Board of Elections 1 1 `"" -- u — Tugust 2008 Amendment Contributions from Individuals Pg i of 3 ❑ Yea ® 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. In Number Elect David Williams MJMVR6 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, &.zip) b. Job Title/Profession it. Comments Attorney David Williams 1014 Exodus Court Monroe, NC 28110 r. Employer's Name/Specific Field Self Legal Services e. Election Sum to Date $ 4,536.85 f Prior g. Account Code h. Form of Payment I. In -Kind Description J. Date.(mm/dd/yyyy) k. Amount ❑ z electronic 01/16/2020 $ 4,000.00 ❑ $ 3. Contributor Information ® Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) It. Job Thle/Profession it. Comments Software Developer James D. Cook 195 Lyndon St #B Greensboro, NC 27401 c. Employer's Name/Specific Field Self e. Election Sum to Date $ 100.00 E Prior g. Account Code b Form of Payment i. In -Kind Description J. Date (mm/dd/yyyy) k. Amount - ❑ z check 01/03/2020 $ 100.00 ❑ $ ❑ $ 3. Contributor Information ® Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Professiou it. Comments Technical Support Coordinator Mark Willis 6506 Conifer Circle Indian Trail, NC 28079 c. Employer's Name/SpecificField Verizon e. Election Sum to Date $ 50.00 f. Prior - g. Account Code h. Form of Payment 1. In -Kind Description J. Date (mm/dd/yyyy) - k, Amount - ❑ z electronic 01/11/2020 $ 50.00 ❑ $ ❑ $ 4. Total only this Page CAMPAIGN FINANCE $ 4,150.00 5. Total of ALL CRO -1210 Pages FFR 2 ll 2020 (This line nmsl be an line 6 ojDerailed Sununary Page CRO -1100) $ 6,440.40 CRO -1210 NC State Board of IIIs 9 April 2007 .t -: 6F_ . , Amendment Contributions from Individuals Pg 2 of 3 ❑ 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 Elect David Williams MJMVR6 3. Contributor Information ® Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, &.zip) b. Job Title/Profession d. Comments Vice -President Anthony Rodriguez 1420 Willow Ridge Ln Waxhaw, NC 28173 c. Employer's Name/Specific Field Goodall Consulting e. Election Sum to Date $ 100.00 f. Prior g. Account Code h. Form of Payment 1. In -Kind Description j. Date.(mm/dd/yyyy) k. Amount ❑ Z electronic 01/16/2020 $ 100.00 ❑ $ ❑ $ 3. Contributor Information ® Add ❑ Remove a. Full Name, Mailing Address &Phone (include city, state, & zip) b. Job Title/Profession it. Comments Employer Representative Carole Dillinger 8223 Waxhaw Creek Rd Waxhaw, NC 28173 c. Employer's Name/Specific Field' Unemployment Services, Inc. e. Election Sum. to Date. $ 20.20 f. Prior g. Account Code h. Form of Payment i.ln-Kind Description j. Date(mm/dd/yyyy) . k. Amount ❑ Z electronic 01/21/2020 $ 20.20 ❑ $ ❑ $ 3. Contributor Information ® Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments Software Developer John Underwood 1301 Shawcroft Ct Apex, NC 27502 c. Employer's Name/Specific Field UNC Healthcare e. Election Sum to Date $ 20.20 E Prior ; g. Account Cade h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) it. Amount ❑ Z electronic 01/21/2020 $ 20.20 ❑ $ ❑ $ 4. Total only this Page UNION COUNTY $ 140.40 5. Total of ALL CRO -1210 Pages ., (Tills line nmst he on line 6 ojDelailed Summary Page CRO -1100) V $ 6,440.40 CRO -1210 NC State Board of Elections April 2UU7 Contributions from Individuals Amendment Pg 3 of 3 ❑ Yes R 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 Elect David Williams MJMVR6 3. Contributor Information ® Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, &zip) b. Job Title/Profession it. Comments Retired Betty Fleming 518 Vinecrest Drive Matthews, NC 28105 c. Employer's Name/Specific Field e. Election Sum to Date $ 50.00 CPrior g. Account Code h. Form of Payment i. In -Rind Description J. Date{mm/dd/yyyy) k. Amount ❑ Z electronic 01/21/2020 $ 50.00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone ..(include city, state, & zip) b. Job Title/Profession it. Comments Farming Delano Cox 6409 Rape Rd Monroe, NC 28112 c. Employer's Name/Specific Field Self e. Election Sum to Date $ 2,000.00 f. Prior g. Account Code h. Form of Payment I. In -Rind Description j. Date (mm/dd/yyyy) :.- k. Amount ❑ z check 02/05/2020 $ 2,000,00 ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name,. Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession it. Comments Retired Thomas W. Currie III 430 Village Commons Blvd Georgetown, TX 78633 c. Employer's Name/Specific Field c. Election. Sum to Date $ 100.00 I: Prior '' g. Account Code b. Form of Payment i. In -Rind Description j. Date (mm/dd/yyyy) k. Amount ❑ z check 02/11/2020 $ 100.00 ❑ $ ❑ UNIC N COUNTY $ 4. Total only this Page $ 2,150.00 5. Total of ALL CRO -1210 Pages FER Z h 2020, (This line em,.si he au fine 6 )fDelailed Suuun(iy Page CRO4100) $ 6,440.40 CRO -1210 NC state Board or-ji tidns. F, �,' April 2007 UNION COUNTY -- CAMPAIGN FINANCE Amendment Disbursements Pg 1 or ❑.. Yes ® No Use this form to report expendituresthe hor2629ee for; operating expenses, contributions to candidate/political m ittanc unfit PnnYll itlAfPlt r,.T PynPirlrrii itureq ........... .--- -...- --- -. 1. Committee Full Name and F I 2. II) Number Elect David Williams MJMVR6 3. Type of Disbursement Please use separate CRO -1310 forms for each type o Disbursement. ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information Lj Add Remove a. Full Name, Mailing Address & Phone include ci state & zi b. Coordinated Committee Name d. Comments Target 6350 Weddington Rd Wesley Chapel, NC 28104 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e.'Election Sum to Date $. 10,45 1: Account Code I g.. Form of Payment 'k. Purpose Code 1. Date (mm/dd/yyyy) j. Amount k. Required Remarks " Z debit K 01/06/2020 $10.65 Paper 4. Payee Information ® Add ❑ Remove a. Full Name, Mailing Address &Phone include city, state &zi b. Coordinated Committee Name - d. Comments kElevtlonum Anedot 10821 Rosebud Ct Baton Rouge, LA 70815 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: to. Date " E Account Code g. Form ofpayment h. Purpose Code 1. Date (mm/dd/yyyy) I J. Amount it. Required Remarks. Z electronic O 01/28/2020 $11.12 processing fees 4. Payee Information ® Add Remove 9. Full Name, Mailing Address &Phone include city, state & zip) b. Coordinated Commit tee Name d. Comments Buttons Online 3906 W. Morrow Dr Glendale, AZ 85308 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ 850.38 C Account Code g Form of Payment h. Purpose Code 1. Date (mm/dd/yyyy) j. Amount it. Required Remarks Z electronic B 01/17/2020 $45.00 palm card desi n Z electronic B 01/21/2020 $805.38 palm cards 5. Total only this Pae $ 872.15 6. Total of ALL CRO -1310 Pages - (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/) olitical Comm) (This line goes in line 13e of Detailed Sunmrary Page CRO.11001f Coordinated Party Expenditures) $ 4,033.43 7.'Purpose Codes List detailed expenditure code is h, above A* - Media B* - Printing C* - Fundraising D - To Mother 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 -._. * Codes require detailed explanation in required remarks field k pan_ t 2 to MO Ct.tr Rnu.d of 171,Mnne n,,—h— wnnq UNION COUNTY Amendment Disbursements CAMPAIGN FINANCE Pg 2 of ❑ Yes ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political :woo t crdi..of,.d a, , nnrlif,lwm 7 4 9n?n 1. Committee Full Name and Fund if a licable 2. ID Number Elect David Williams - MJMVR6 3. Type of Disbursement Please usese /orate CRO -1310 forins for each t ge of Disbursement. ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee ILrformation Add Lj Remove a. Full Name, Mailing Address & Phone included state & zi b. Coordinated Committee Name d. Comments Signmasters 314 Depot St. #B Monroe, NC 28112 . c. Level Registered (Specify) , ❑ Federal ❑ County: ❑ State Municipality: e.. Election Sum to Date $ 2,428.58 E Account Code I g. Form of Payment k. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks z electronic B 01/21.2020 $867.35 signs z electronic B 01/27/2020 $867.35 signs 4. Payee Information Add Remove a. Full Name, Mailing Address & Phone include city, state & zip) b. Coordinated Committee Name d. Comments Signmasters 314 Depot St. #B Monroe, NC 28112 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e.. Election Sum to Date $ 2,428.58 G Account Code - g. Form of Payment hrPurpme Code J. Atnonnt - k. Required'Remarks z electronic B ffDleo(ldd/yyyy) 20 $346.94 big signs z electronic B 02/14/2020 $346.94 big signs 4. Payee Information Add Remove a. Full Name, Mailing Address & Phone (include city, state & zip b. Coordinated Committee Name - d. Comments Facebook 1601 Willow Rd Menlo Park, CA 94025 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ 293.71 C Account Code -I g. Form of Payment h. Purpose Code. Date (,n ldd/yyyy) j. Amount k.. Required Remarks z electronic A 02/03/2020 $293.71 Facebook ads 5. Total only this Page $ 2,722.29 6. Total of ALL CRO -1310 Pages (This /lee goes in lire 13a of Derailed Sunenary Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Derailed Summary Page CRO -1100 if Contrib to Candidates/Polideal Comm) (This lite goes in line 13c ofDelailed Summary Page CRO -1100 if Coordinated Party Expenditures) $ 4,033.43 7. Purpose Codes(List detailed expenditure code in h, above A* - Media B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* r: Equipment G - Political Party H* - Holding Public Office Expenses I - Postage J - Penalties :..K*.- Office Expenses Q* - Donation to Legal Expense Fund O* -Other _... _..... * Codes require detailed explanation in required remarks field k cern_ t a to nrr QOol rin.M of pl. flt T) --l", Ono UNION COUNTY Amendment Disbursements CAMPAIGN FINANCE Pg 3 of ❑ Yes ® No Use this form to report expenditures from the committeg fpr;Qppr)ating expenses, contributions to candidate/political committees and coordinated a FFR expenditures. LL 44 LLll1lLLllll 1. Committee Full Name and Fund if applic2. ID Number Elect David Williams _) MJMVR6 3. Type of Disbursement Please use separate CRO -1310 forms or each type n Disbursement. ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information Add El Remove a. Full Name, Mailing Address & Phone include city, state &.zi b. Coordinated Committee. Name d. Comments TicketLeap 650 Smithfield St Suite 1300 Pittsburgh, PA 15222 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ 175.00 E Account Code g. Form of Payment h. Purpose Code i. Date.(mm/dd/yyyy) j. Amount k. Required Remarks z electronic O 02/03/2020 $175.00 Lincoln- Reagan Dinner 4. Payee Information Add Ej Remove a. Full Name, Mailing Address & Phone include city, state & zip) b. Coordinated Committee Name d. Comments Matt Daly 4579 River Pkwy Apt,J Atlanta, GA30339 c.. Level. Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ 200.00 CAccount .Code g. Form of Payment h. Purpose Code - 1. Date (mm/dd/yyyy) J. Amount it. Required Remarks Z check A 02/10/2020 $200.00 website $ 4. Payee Information M Add Ej Remove a. Full Name, Meiling Address & Phone include city, state & zip) b. Coordinated Committee Name d. Comments Union Cty Chamber of Commerce 903 Skyway Drive Monroe, NC 28110 -c. Level. Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: c. Election Sum to Date $ 15.00 f. Account Code I g. Form of Payment I h. Purpose Code -1. Date (mm/dd/yyyy) J. Amount it. Required Remarks Z electronic O 02/12/2020 $15.00 Meet ti Greet -Reception ............. ............ 5. Total only this Pae $ 390.00 6. Total of ALL CRO -1310 Pages (Tbls file goes in line 13a of Delaffed Sunrnmry Page CRO -1100 if Operating Expenses) (This line goes in line 13b ofDemifed Surnnmry Page CRO -1100 if Contrib to Candidates/Pofitical Conmr) (This line goes in line 13c ofDelailed Summary Page CRO -1100 if Coordinated Party Expendiuees) $ 4,033.43 7. Purpose Codes List detailed expenditure code in h, above A* - Media B* - Printing C* - Fundraising 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 -.. * Codes require detailed explanation in required remarks field k) /`A/1_ I1111 NO Gatr. Rnard of Flrrlinnc TI", 'hr 9n0u UNION COUNTY -- CAMPAIGN FINANCE 1 Amendment Disbursements Pg 4 of 4 i ❑ _ Yes ® No Use this form to report expenditures from the cp4aMitil fnNerating expenses, contributions to candidate/political committees and coordinated Darty expenditures. 1. Committee Full Name and Fund if applicable) `'-' a. a 77 r w 2. ID Number Elect David Williams I MJMVR6 3. Type of Disbursement Please use separate CRO -1310 forms for each type o Dishunsement. ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information M Add Ej Remove a. Full Name;: Mailing Address & Phone include ci state & zip) b. Coordinated Committee Name d. Comments Tractor Supply Company 1010 W. Roosevelt Blvd Monroe, NC 28110 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ 48.99 E Account. Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) J. Amount it. Required Remarks Z electronic O 02/13/2020 $48.99 sign posts 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 E Account Code g.. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) J. Amount it. Required Remarks $ $ 4. Payee Information Add F1 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 $ 1. Account Code g. Form of Payment It. Purpose Code i. Date (mmldd/yyyy) j. Amount it. Required Remarks $ 5. Total only this Pae $ 48.99 6. Total of ALL CRO -1310 Pages (This line goes in line 13a of Detailed Sunmrary Page CRO -1100 if Operating Expenses) (This line goes in line 136 of Delailed Sumnmry Page CRO -1100 if Contrib m Cnudidates/Polideal Conan) (This line goes in line 13c of Detailed Sununary Page CRO -1100 if Coordinated Party Expenditures) $ 4,033.43 7. Purpose Codes List detailed expenditure code in h, above A* - Media B* - Printing C* - Fundraising 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 * Codes require detailed explanation in required remarks field k) pnn_ 1 t rn Mr ctntP Rnarcl of Flnrtinne rP�P�nnnr'naiu