Williams,David_2020-2nd-qtrAmendment
Disclosure Report Cover I ❑ Vee ® 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 undate information
1. Committee Information'
a. Full Name
c. ID Number
Elect David Williams
MJMVR6
b. Mailing Address (include City, State and Zip Code)
d. Date Filed
P.O. Box 2276
07/01/2020
Indian Trail, NC 28079
e. Phone Number
980-328-4408
2. Report Year
3. Period Start Date (mm/ddlyy)
4. Period End Date
mm/dd
5. Treasurer Full Name
2020
02/16/2020
06/30/2020
David H. Williams
6. Type of Committee Check One
9. Type of Report
check only one type of report
om one category)
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑ Organizational
❑ Organizational
❑ Organizational
❑ PAC ❑ Referendum
Independent ❑ Joint Fundraiser
❑ Expenditure
❑ Thirty-five day
Quarterly
❑ Pre -referendum
Legal Expense Fund
❑ Pre-primary,
❑ Preelection
❑ First
® Second
❑ Final
❑ Supplemental Final
7. T e of Fund (if applicable, check one)
❑ 'Booster Fund"
❑ Building Fund
❑ Pre-rutmff
❑ Third
❑ Annual
Semi-annual
❑ Fourth
❑ Special
❑ Mid Year
Semi-annual
❑ Other:
❑ Year End
❑ Mid Year
14. Special Report Name
❑ Final
❑ special
❑ Year End
❑ Final
❑ special
8. Number of Fundraisers this Re ort
0
11. Account Information
11. Account Informati,
a. Financial Institution Full Name
a. Financial Institution Full Name
BB&T
b. Purpose
c. Account Code
c. Account Code
Campaign
Donations
Z
JUL 0 t 2020
d. Period Begin Balance
it. Period Begin Balance
and
$ 3,391.31
$
Expenditures
Union Go. Board of Elections
CERTIFICATION
I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B, & 2213-22M 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 I have been trained by the NC
to 13oar ofE'� le tions.
David H. Williams
��Fu� 07/01/2020
Printed Name of Signer Signature
of Appointed Treasurer
Date
FOR OFFICE USE ONLY
Date Received: *_1 oho Employee:
Delivery Method
❑ Normal Mail
Date Postmarked: Employee:
Registered Mail
Hand Delivered
Date Scanned: 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 -21 OA -E) to make committee changes.
rRn-1000 Nr State Roard of Ftrrtinnc Au.mt 90ox
VIn t IN lam a ns
Detailed Summary ❑ tes ❑ .,,
Use this form to summarize all disclosure ieportnw, forms and to total monetary information.
1. Committee Full Name and Fund if applicable)
2. Type
of Report
3. ID Number
Elect David Williams
Second Quarter
MJMVR6
Start of Election Cycle: January 1, 2017
Total this
Reporting Period
Total this
Election ('vele
4) Cash on Hand at Start
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
1lb) Contributions from Not -for -Profit Organizations
I lc) Outside Sources of Income
I ld) Legal Expense Fund — Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1210)
(CRO -1230)
(CRO -1410)
(CRO -1140)
(CRO -1250)
(CRO -1150)
(CRO -1150)
(CRO -1270)
(CRO -1165)
$
$
3,391.31
$
$
0.00
$ 100.00 $
7,477.25
$ $
$ $
184.34
$ $
$ $
$ $
$ $
$ $
$ $
$ $
12)
TOTAL RECEIPTS (Add lines 5, 6, 7, 8, 9, 10, Ila, 116, Ile, 11d and Ile)
$
100.00
$
7,661.59
13)
14)
15)
16)
17)
Disbursements
13a) 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 -1410)
(CRO -1320)
(CRO -1510)
$
2,834.36
$
6,867.79
$ $
$ $
$ $
$ $
$ $
$ $
136.85
18)
TOTAL EXPENDITURES (Addlims 13a, 13b, 13e,, 14, 15, 16and 17)
$
2,834.36
$
7,004.64
19) Cash on Hand at End (Add lines 4and12 together, then subtract line 18)
$
656.95
$
656.95
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 tI
Administrative Support `N���`1 V E D
Forgiven Loans JUL 01 2020
48 -Hour Notice Reports Su
inion Co. Board of Elections
Contributions to be Refunded
(CRO -1330)
(CRO -1430)
(CRO -1610)
(CRO -1620)
(CRO -1710)
(CRO -1710)
(CRO -1440)
(CRO -2220)
(CRO -1215)
$
$
$
$
$
$ $
$ $
$ $
$ $
CRO -1100 NC State Board of Elections August 2008
Amendment
Contributions from Individuals Pg 1 of I ❑ 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 0. illiams
MJMVR6
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
Farming
Ruth Cox
6002 Cox Rd
Monroe, NC 28112
cEmployer's Name/Specific Field
Self
e. Election Sum to Date
$ 100.00
E Prior
g. Account Code
h. Form of Payment
i. In -Kind Description
J. Date (mm/ddtyyyy)
it. Amount
❑
Z
Check
03/02/2020
$ 100.00
3. Contributor Information ❑ Add ❑ Remove
a. Full 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
E Prior
g. Account Code
Is. Form of Payment
i. In -Kind Description
J. Date (mm/dd/yyyy)
k. Amount
❑
$
❑
$
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, s REMEIVED
JUL O 1 2020
Union Co. Board of Eluctiona
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)
k. Amount
❑
$
❑
$
4. Total only this Page $ 100.00
5. Total of ALL CRO -1210 Pages $ 100.00
(This line nuw be on am 6 ojDerafled Summary Page CRO -1100)
CRO -1110 NC State Board of Elections April 2007
Amendment
Disbursements Pg 1 of 2 ❑ Yes ® No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
committees and coordinated narry expenditures.
1. Committee Full Name and Fund itapplicable) 2. —ID Number
Elect David Williams MJMVR6
3. Type of Disbursement Please use separate CRO -1310 formn for each type of Disb rsement
Operating Expenses ❑ Contributions to CandidatesiPnlitical Committees ❑ Coordinated Pan) Expenditures
4. Payee Information Add n Remove
a. Full Name, Mailing Address & Phone
include cill, state & a
b. Coordinated Committee Name
dtREW EIVED-
J U L 01 2020
Union CO. Board of Elections
Tractor Supply Company
1010 W. Roosevelt Blvd
Monroe, NC 28110
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality:
e. Election Sum to Date
$ 122.63
f. Account Code
g. Form of Payment
h. Purpose Code
t. Date (mm/dd/yyyy)
j. Amount
It. Required Remarks
Z
electronic
O
02/18/2020
$73.64
Sign post
supplies
4. Payee Information Fj Add Remove'
a. Full Name, Mailing Address & Phone
include citv. state & zip)
b. Coordinated Committee Name
d. Comments
Amazon Marketplace
440 Terry Ave N
Seattle, WA 98108
c. Level Registered (Specify)
❑ Federal ❑ County
❑ State ElMunicipality:
e. Election Sum to Date
$ 14.18
f. Account Code
g. Form of Payment
It. Purpose Code
i. Date (mm/dd/yyyy)
J. Amount
k. Required Remarks
Z
electronic
O
02/18/2020
$14,18
name tag
4. Payee Information Add Remove
a. Full Name, Mailing Address & Phone
include city, state & zip)
b. Coordinated Committee Name
d. Comments
WIXE
1700 Buena Vista Rd
Monroe, NC 28112
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality:
e. Election Sum to Date
$ 1,505.00
E Account Code
g. Form of Payment
It. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
Z
electronic
A
02/21/2020
$1,505.00
Radio ads
S
5. Total only this Pae S 1,592.82
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/Political Comm)
(This line goes in line 13e of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures)
$ 2,8343.6
7 Purpose Codes List detailed expenditure code in h. above
A* - Media B* - Printing C* - Fundraising D - To Another Candidate
E - Salaries F* - Equipment C - Political Party H* - Holding Public Office Expenses
- Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* - Other
*':Codes require detailed explanation in required remarks field k
!`a/L 11 In Nr Cw,a P—M ,.r rl"" innc Nnou
Amendment
Disbursements Pg 2 of 1 ❑ 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.ID Number
Elect David Williams I MJMVR6
3. Type of Disbursement Please use separate CRO -1310 forms for each type of Disbursement
Operating Expenses ❑ Contributions to Candidates.Political Committees ❑ Coordinated Pam, Expenditures
4. Payee Information n Add M Remove
a. Full Name, Mailing Address & Phone
include city, stat & zip)
b. Coordinated Committee Name
JUL 01 2020
Won Co. Board of Elections
BB&T
200 Indian Trail Rd N
Indian Trail, NC 28079
c. Level Registered (Specify)
❑ Federal ❑ County:
State ❑ Municipality:
e. Election Sum to Date
$ 1.25
E Account Code
g. Form of Payment
Is. Purpose Code
i. Date (mm/dd/yyyy)
J. Amount
k. Required Remarks
Z
electronic
O
02/21/2020
$1.25
bank charge
4. Payee Information Add El 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
$ 1,534.00
f. Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/yyyy)
J. Amount
k. Required Remarks
Z
electronic
A
03/02/2020
$312.02
Facebook ads
Z
electronic
A
03/162020
$659.41
Facebook ads
4. Payee Information Add Remove
a. Full Name, Mailing Address & Phone
include city, stat & a
h. 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
$ 1,534.00
E Account Code
g. Form of Payment
h. Purpose Code
1. Date (mm/dd/yyyy)
J. Amount
k. Required Remarks
Z
electronic
A
04/012020
$282.80
Facebook ads
Z electronic A 05/20/2020 $- 13.94 Facebook ads
credit
5. Total only this Pae S 1,241.54
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed Sumnmry Page CRO -1100 if Operating Expenses)
(This line goes in line 13b of Detailed Summary Page CRO -11001f Conrrib to CandidatesiPoliical Comm) $ 2,834.36
(This line goes in line 13c of Detailed Summmg Page CRO -1100 if Coordinated Party Expenditures)
7. Purpose Codes List detailed expenditure code in above
A* - Media B* - Printing C* - Fundraising D - To Another Candidate
E - Salaries F* - Equipment G - Political Pam H* - Holding Public Office Expenses
1 - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* - Other
* Codes require detailed explanation in required remarks field k
i1un_ r r rn ur Garr n—n .,r n--h—nnno