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)
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