Williams,David_2020-3rd-qtrAmendment
Disclosure Report Cover ❑ les ® No
tJNe 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
I. Committee Information
a. Full Name
c- to Number
Elect David Williams
MJMVR6
b. Mailing Address (include City, State and Zip (ode)
d. Date Filed
P.O. Box 2276
02/24/2020
Indian Trail. NC 28079
e. Phone Number
980-328-4408
2. Report Year
3. Period Start Date (mm/dd/yy)
`I• Period End Date
5. Treasurer Full Name
(mm'dd'%c)
David H. Williams
2020
07/01/2020
10 17 2020
6. Type of Committee (Check One)
9. Type
of Report ('check onl • one f ym 0/ IT ort rom one cote gwl9
® Candidalc C'aulpaigo ❑ Poll)
Municipal
State/Counh
Referendum
❑
Organizational
❑ Organizational
❑ 0manizslional
❑ PAC ❑ Referendum
Indelxndem ❑ Joinl Fundraiser
❑
Thiry -lice day
Ouarlerly
❑ Pre -referendum
❑ Eapendilure
Legal Fslxnse Fund
❑
❑
Pre-prawrcEl
Preelection
First
❑ Second
E]Final
❑ Supplemental Final
7. Type of Fund (fopplicable. check one)
❑ "Booster Fund"
❑ Building Fund UNION COUNTY
Llpre-nntnff
® Third
ElAnnual
CAMPAIGN FINANCE
Semi-annual
❑ Fourth
❑ Special
r) C O 2020
G
OCT1. L
E]
Mid Year
Semi -arcual
❑ Olhcr.
❑
Year End
❑ Mid Year
10. S pecial Report Name
❑ Final
❑ special
❑ Year End
❑ Final
❑ Special
8. Number ofFundr s r
II
11. Account Information
11. Account Information
a. Finmreial Institntion Full Name
a. Financial Institution Fail Name
BB&T
b. PnI pose
C. Account Code
It. Purpose
c. account Code
Campaign
Z
donations &
d. Period Begin Balance
d. Period Begin Balance
expenditures
S 656.95
$
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 fiords 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 State Board of ections.
/qy Z L (L (/
dob4,
David H. Williams
V • lo
Printed Nmw,d Signer
Siglatureof Appointed Tr su r
Dale
FOR OFFICE USE ONLI
Delivery Method
Date Received:
Employee: ❑ Normal Mail
❑ Registered Mail
Date Postmarked:
Employee: ® Hand Delivered
❑ Electronically Filed
Dale 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-2I00A-E) to make committee changes.
rpt)- I nnh NC M.0, 1L.ard of Flriiinnc A la....I 1ImR
Amendment
Detailed Summary ❑ des El
Use this form to suounarize all disclosure reporting forms and to total monetmti information.
1. Committee Full Name (and Fund if applicable)
2. Tvpe of Report
3. ID Number
Elect David Williams
Third Own ter Plus
MJMVR6
Start of Election Cycle: January 1, 2017
Total this
Reporting Period
Total this
Election CN Cie
4)
Cash on Hand at Start
$
656.95
$
u.ou
RL*( 1�TS amu' ,:r1
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
I la) Interest on Bank Accounts
I Ib) Contributions from Not -for -Profit Organizations
1 le) Outside Sources of Income
I Id) Legal Expense Fund —Other Sources
I I e) Exempt Purchase Price Sales
(CRO -1205)
(CRO -121)
(CRO -1230)
(CRO -1230)
(CRO -1419)
(CRO -124(
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
1�tk i:r ft
$ 8020
$
80.20
$ 1900.00
$
9,377.25
$
$
$
$
184.34
$
$
$
$
$
$
$
$
$
$
$
$
12)
TOTAL RECEIPTS Ladd lure ?. b. '. 3. 9. 10, Ilu. Ilh. Ile. IIdaed llmt
$
1981110
$
9,641.'9
EXPENDITURES
13) Disbursements
13a) Operating Expenditures
13b) Contributions to Candidates/Political Committees
13c) Coordinated Party Ex 6Q�gsOUNTY
C MPAIGN FINANCE
14) Aggregated Non -Media Expenditures
15) Loan Repayments OCT 2 6 2020
16) Refunds/Reimbursements ntOtllENE9
17) In -Kind Contributions
/CRo-Ltlm
(CRO -1310)
(CRO -1-410)
(CRO -1315)
(CRO -1420)
(CRO -1.120)
(CRO -1510)
$ 392.69
$
7,260.48
$
$
$
$
$
$
$
$
$
$
$
$
136.85
18)
TOTAL EXPENDITURES (dddhne.s13u.13h.13e.14.15.16mrd17)
$
392.69
$
7397.33
19)
Cash on Hand at End (.0,11ines 4 and 121ogeiher. Oren .suhlracr /ore 18)
$
2244.46
$
2244.*,
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)
(CR0-1430)
(CRO -1610)
(CRO -1620)
(CRO -1710)
(CRO -1710)
(CRO -1440)
(CRO -2220)
(CRO -121.5)
$
$
$
$
$
$
$
$
$
$
$
$
CRO -1100 NC State Board of Elections Aucost '_W8
Amendment
Aggregated Contributions from Individuals Page i or I ❑ Yes ® No
ODtional form used to report NC Contributions From Individuals of $50 or less
1. Committee Full Name and Fund if applicable)
2. ID Number
Elect David Williams
MJMVR6
3. Contributor Information
a. Amend
c. Form of Payment
d. In -Kind
Deseri tion
e. DateGAmount
mm/dd/Ada
lb.Account
Electronic
07/16/2020
$ 50.00
RemoveAdd
Electronic
07/16/2020
$ 20.20
Remove
Add
Z
Electronic
07/16/2020
$ 10.00
ElRemove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
UNION COUNTY
CAMPAIGN FINANCE
$
Remove
Add
C 6 T 202U
OCTC
$
Remove
Add
RECEIVED
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
Add
$
Remove
4. Total only this Page
$ 80.20
5. Total of ALL CRO -1205 Pages
(This line must be on line 5 of Detailed Summary Page CR0.1100)
$ 80.20
CRO -1105 NC State Board of Elections April 2007
Amendment
Contributions from Individuals Pg I of 2 ❑ Yes ® No
I icr this fnrm to renori 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
Not employed (Retired)
Elizabeth Williams
6623 Mimosa Lane
Dallas, TX 75230
c. Employer's Name/Specific Field
N/A
e. Election Sum to Date
$ 700.00
f. Prior
g. Account Code
Is. Form of Payment
i. to -Kind Description
J. Date (mm/dd/yyyy)
k. Amount
❑
Z
Electronic
07/16/2020
$ 100.00
❑
Z
Electronic
08/16/2020
$ 100.00
❑
Z
Electronic
09/16/2020
$ 100.00
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
it. Comments
Not employed (Retired)
Elizabeth Williams
6623 Mimosa Lane
Dallas, TX 75230
e. Employer's Name/Specific Field
N/A
e. Election Sum to Date
$ 800.00
I. Prior
g. Account Code
h. Form of Payment
I. In -Kind Description
j. Date (mm/dd/yyyy)
k. Amount
❑
Z
Electronic
10/16/2020
$ 100.00
❑
$
❑
$
3. Contributor Information ® Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include city, state, &•rip)
b. Job Title/Profession
d. Comments
Builder
Robert Harrell CAMPAIGN FINANCE
5615 Potter Road
Matthews, NC 28104 OCT Z 6 2020
RECEIVED
c. Employer's Name/Specific Field
Self
e. Election Sum to Date
$ 1000.00
E Prior
g. Account Code
b. Form of Payment
i. In -Kind Description
j. Date (mm/dd/yyyy)
It. Amount
❑
Z
Electronic
10/14/2020
$ 1000.00
4. Total only this Page $ 1400.00
5. Total of ALL CRO -1210 Pages $ 1900.00
(chis line mist be on line 5 of Detailed Summar' Page CRO -1100)
CRO -1110 NC Swe Board of Elections April 2007
Amendment
Contributions from Individuals Pg 2 of z ❑ les ® No
I Ise this form to renort 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, hlailiug :Address & Phone
(include cit)', state. & zip)
b..lob Title/Profession
d. Commenls
Accountant
Fern Shubert
505 S. Elm Street
Marshville, NC 28103
c. Employer's Name/Specific Field
Self
e. Election Sum to Dote
$ 250.00
C Priar
g. Account Code
It. Form of Payment
i. In -Kind Description
j. Date Imm/dd/vc})1
k. Amount
❑
Z
Check
09/15/2020
$ 1�o lnl
3. Contributor Information ® Add ❑ Remove
a. Fall Name, Mailing Address & Phone
(include city, state. & zip)
h. lob Title/Profession
J. Comments
Real Estate
Wesley McCaskill
4725 John Craig Road
Waxhaw. NC 28173
c. Employer's Name/Specific Field
Self
e. Election Sum to Date
$ 250.00
G Prim
g. Account Code
It. Form of Payment
i. In -Kind Description
j. Date (mm/dd/)yyy)
k. Amount
❑
Z
Check
10/13/2020
$ 250.00
3. Contributor Information ❑ Add ❑ Remove
a. Full Name, Mailing Address & Phone
(include cite, stale. &zip
h lob Tine/Profession
J. Comments
CAMPAIGN FINANCE
OCT 2 6 2020
RECEIVED
e Employer's Name/Specific Field
e. Election Stem to Date
$
L Prim
g. Account Code
It. Form of Payment
i. [it -Kind Description
j. Date Dum/dd/y}w)
k. Amount
❑
$
❑
$
4. Total only this Page $ 500.00
5. Total of ALL CRO -1210 Pages $ 1900.00
(This line mist he art fine 6 of Derailed Summary Page CRD -1100)
CRO -1210 NC' State Board of Elecoons April 2(9)7
Amendment
Disbursements Pg 1 of a ❑ Yes ® No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
�..a crdinated .,�.n, nvnnndin,rrc
................... ...... _.,.,......_.__ —.. -.. --------
1. Committee Full Name and Fund if applicable) 2. ID Number
Elect David Williams MJMVR6
3. Type of Disbursement Please use separate CRO -1310 forms for each twe of Disbursement.
® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Pany Fxpenditures
4. Payee Information Add Remove
a. Full Name, Mailing Address & Phone
include city, state & zip)
It. Coordinated Committee Name
d. Comments
Anedot
10821 Rosebud Court
Baton Rouge, LA 70815
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality:
e. Election Sum to Date
$ 23.83
t. Account Code
g. Form of Payment
It. Purpose Code
I. Date (mm/dd/yyyy)
j. Amount
it. Required Remarks
Z
electronic
O
07/16/2020
$8,41
processing fee
Z
electronic
O
08/16/2020
$4.30
processing fee
4. Payee Information Add Remove
a. Full Name, Mailing Address & Phone
include city, state & zip)
b. Coordinated Committee Name
d. Comments
Anedot
10821 Rosebud Court
Baton Rouge, LA 70815
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality:
e. Election Sum to Date
$ 68.43
f. Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/yyyy)
J. Amount
it. Required Remarks
Z
electronic
O
09/16/2020
$4.30
processing fee
Z
electronic
O
10/14/2020
$40.30
processing fee
4. Payee Information -El Add Remove
it. Full Name, Mailing Address & Phone
include city, statet & zip)
b.Coordinated Committee Name
d. Comments
Anedot CAMPAIGN FINANCE
10821 Rosebud Court
Baton Rouge, LA 70815 OCT 2 6 2020
RECEIVED
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State Municipality:
e. Election Sum to Date
$ 72.73
C Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
it. Required Remarks
Z
electronic
O
10/16/2020
$4.30
processing fee
5. Total only this Pae
$ 61.61
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Delailed Summary Page CRO -1100 if Operating Expenses)
(This fine goes in line 136 of Derailed Summary Page CRO -1100 If Contrib to Candidales/Political Comm)'i $ 392.69
(This line goes in fine 13c of Detailed Summary Page CRO -1100 if Coordinated Party Expenditures)
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 Pam H* - Holding Public Office Expenses
I - Postage 3 - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* - Other
* Codes require detailed explanation in required remarks field it
/'Rrl_ i ] in Nr C,a,r R—M „r ph—h—, 1-1---h— 'nou
Amendment
Disbursements Pg 2 of a ❑ ''ec ® No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
rnmmittrrc and ennrdinated nark, exnenditures.
1. Committee Full Name and Fund if applicable)
2. ID Nmnber
Elect David Williams
MJMVR6
3. Type of Disbursement Please ase separate CRO -1310 fednits for each type of Disburseluent.
Olxrating Expenses ❑ Conn"ibulions to Candidates Political Conuniuecs ❑ C,wrdinated Parc Expendinn"es
4. Payee Information Add Remove
a. Full Name, Mailing Address & Phone
(include Pitt. state. & zip)
b. Coordinated (tanni tlee Name
it. Comments
Facebook
1601 Willow Road
Menlo Park, CA 94025
c Level Registered (Specify)
❑ Federal ❑ county:
state Municipality:
e. Election Sum to Date
$ 1717.02
f. Account Code
g. Form of Pavment
h. Purpose Code
i. Date (nim/dd/yyyy)
j. Amount
k. Required Remarks
Z
Elextronic
A
10/01/2020
$133,02
Facebook ads
Z
Electronic
A
10/13/2020
$50.00
Facebook ads
4. Payee Information ❑ Add Remove
a. Fall Name. klailiug Address & Phone
(include cit\', state, & Zip)
b. Coordinated Committee Name
d. Comments
Facebook
1601 Willow Road
Menlo Park, CA 94025
c Level Registered (Specify)
❑ Federal ❑ Courtly
El State El Municipality:
e. Election Stein to Date
$ 1742.02
I'. Account Code
g. Form or Payment
It. Purpose Code
i. Date (om/dd/yyyy)
j. Amount
k. Required Remarks
Z
Electronic
A
10/15/2020
$25.00
Facebook ads
4. Payee Information Add Remove
it. Fall Name. Mailing Address & Phone
(include cin', state, & zi )
b. Coordinated Committee Name
d. (moments
13 Brothers
120 Blythe Drive CAMPAIGN FINANCE
Indian Trail, NC 28079 OCT 2 6 2020
RECEIVED
c. Level Registered (Specif))
❑ Federal ❑ County:
El state ❑ Municipality
e. Election Sum to Date
$ 100.00
L Account ('ode
g. Form of Payment
h. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
k. Required Remarks
Z
Electronic
O
10%1-4'2020
$100.00
Patriotic rally
5. Total only this Pae $ 308.02
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 Sunumrrr Page CRO -1100 if Contrib to Condidates/Political Conlin) $ 392.69
(This lure goes in line 13c if Detailed Sununnrr Poge CRO -1 /Oil it Coordinated Party Expenditures)
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 A - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* - Other
* Codes requirt detailed explanation in required remarks field (k
/`Arlt_ 12 /it no` G 11 nmvd of Flrrtinnc n,.r.n.hNr 11114
Amendment
Disbursements Pg I of a ❑ yes ® No
Use this form to report expenditures from the committee for: operating expenses, contributions to candidate/political
enmmittees and ennrdinated nartv exnenditures.
1. Committee Full Name and Fund if applicable) 2. ID Number
Elect David Williams MJMVR6
3. Type of Disbursement tRfeae use separate CRO -1310 forms for each troe of DisburvetneftLjl
Illxraong Eslxnses ❑ Contributions to (:mdidates Political Coni niuees ❑ Coordinated Parti Expenditures
4. Payee Information Add Remove
a. Full Name. Mailing Address & Phone
include cilx', stale. & zip)
It. ('oordinated Committee Name
d. Continents
The Patriot Wagon -USA, LLC
3718 Plyler Mill Road
Waxhaw, NC 28112
c Level Registered (Specify)
❑ Federal ❑ county:
El State Municipality:
e. Election Sum In Date
$ 23.06
f. .Account Code
g. Form of Payment
It. Purpose Code
i. Date (mm/dd/yyyy)
j. Amount
Is. Required Remarks
z
Electronic
O
09'11202023
$23,06
Rallv ticket
4. Pavee Information Add Remove
a. Fill Name, Nlailing Address & Phone
include cit%, slate, & zip)
b. Coordinated Committee Name
it. Comments
e Leel Registered (Speciry)
❑ Federal ❑ County:
Stale Municipality:
e. Election Sum to Date
f. Account Code
g. Form or Payment
h. Purpose Cade
i. Dale (mm/dd/yyyy)
J. Amount
k. Required Remarks
$
4. Payee Information Add Remove
a. Full Name. Mailing Address & Phone
include cit%, stale. & '
CAMPAIGN FINANCE
ft
OCTl• 2 6 2020
RECEIVED
b. Coordinated Committee Name
d. Com meals
c. Le%ei Registered (Specify)
❑ Federal El County:
❑ State ❑ Municipality:
e. Election Sum to Date
$
f. Account Code
I g. Form of Payment
h. Purpose Code
i. Date (mm/ddA1%%%)
j. Amount
k. Required Remarks
$
$
5. Total only this Pate $ 23.06
6. Total of ALL CRO -1310 Pages
(This line goes in line 13(t o%Delailed Sunnrwrr Page CRO -1100 if Operating Expenses) $ 392.69
(This line goes in line 13b of Detailed Suunuarr Page CRO -1100 ifContrib to Candidares/Poliacal Conrnq
(This line goes in line 13e o1'Detuiled Sunnwrr Page CRO -/100 if Courrlintrred P(tre• Fapenr imres)
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 - Polilical Pang H* - Holding Public Office Expenses
1 - Postage .1 - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* - Other
* Codes require detailed explanation in required remarks field (k)
r,nn-I? It) air o,,,. R..*r.i.,f ",... rh•.+mMr lmW