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Williams,David_2020-4th-qtrAmendment Disclosure Report Cover I ❑ Yes E No Use this form for general report and committee information, must be signed and submitted along with other detailed fonns. Do not use this form to update 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 Indian Trail, NC 28079 01/12/2021 e. Phone Number 980-328-4408 2. Report Year 3. Period Start Date (mm/dd/yy) 4. Period End Date 5. Treasurer Full Name mm/dd David H. Williams 2020 10/18/2020 12/31/2020 6. Type of Committee Check One 9. Type of Report check only one type of report ran one care o E Candidate Campaign ❑ Party Municipal State/County Referendum ❑ PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational Independent Joint Fundraiser ❑ Expenditure ❑ Thin five da ❑ Y- Y Quarterly ❑ Pre•referendum Legal Expense 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 E Fourth ❑ Special ❑ Mid Year Semi-annual ❑ Other: ❑ Year End ❑ Mid Year 10. Special Report Name ❑ Final ❑ Special ❑ Year End ❑ Final ❑ Special 8. Number of Fundraisers this Report 0 11. Account Information 11. Account Information a. Manurial Institution Full Name a. Financial Institution Full Name BB&T b. Purpose c. Account Code b. e. Account Code Campaign donations& Z JAN i X2021 d. Period Begin Balance d. Period Begin Balance expenditures S 2,241.46 s RECEIVED 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 StAe Boardf Electio s. QJ J 2 David H. Williams Zo2I Printed Name of Signer Signature of App inted Treasurer Date FOR OFFICE USE ONLY Date Received: !j_ Employee: / Delivery Method El Normal Mail ! Registered Mail Date Postmarked: Employee: 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. 1 -Ar )_ 1 MMM Nr grate Rnard of Fleotirm A uoncr MOR Amendment Detailed Summary ❑ "es ® No Use this form to summarize all disclosure reporting forms and to total monetary information. 1. Committee Full Name and Fund if applicable) 2. Type of Report 3. ID Number Elect David Williams Fourth Quarter MJMVR6 Start of Election Cycle: January 1, 2017 Total this Total thisReporting Period Election Crrlr 4) Cash on Hand at Start S 2244.46 $ 0.00 RF(TIPTS 5) Aggregated Contributions from Individuals ((RO-1305) $ 50.00 $ 13020 6) Contributions from Individuals (CRO -1210) $ 200.00 $ 9,577.25 7) Contributions from Political Party Committees (CRO -1220) $ $ 8) Contributions from Other Political Committees (CRO -1230) $ $ 184.34 9) Loan Proceeds (CRO -1410) $ $ 10) Refunds/Reimbursements To the Committee (CRO -1140) $ $ 11) Other Receipt Sources ::- Ila) Interest on Bank Accounts (CRO -1250) $ $ I I b) Contributions from Not -for -Profit Organizations (CRO -1250) $ $ I Ic) Outside Sources of Income (CRO -1250) $ $ 11d) Legal Expense Fund — Other Sources (CRO -1270) $ $ 11 e) Exempt Purchase Price Sales (CRO -1265) $ $ 12) TOTAL RECEIPTS (Addlines5, 6, 7, 8, 9, 10, Ila, Ilb, 11c, 11dand lie) $ 250.00 $ 9,891.79 EXPENDITURES.:; 13) Disbursements 13a) Operating Expenditures (CRO -1310) $ 1,192.80 $ 8,453.28 13b) Contributions to Candidates/Political Committees (CRO -1310) $ $ 13c) Coordinated Party Expenditures (CBO -1310) $ $ 14) Aggregated Non -Media Expenditures (CRO -1315) $ $ 15) Loan Repayments (CRO -1420) $ $ 16) Refunds/Reimbursements From the Committee (CRO -1310) $ $ 17) In -Kind Contributions (CRO -Isco) $ $ 136.85 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14,15,16and 17) $ 1,192.80 $ 8,590.13 19) Cash on Hand at End (Addlines4and 12 together, thenmitraetline 18) $ 1,301.66 $ 1,301.66 ADDITIONAL INFORMATI 20) Non -Monetary Gifts Given to Other Committees (CRP -1330) $ 21) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) $ 22) Debts and Obligations owed By the Committee (CRO -1610) $ 23) Debts and Obligations owed To the Committee (CRO -1620) $ 24) Account Transfers WithLTC6ttT0I1 ,NCE (CRO -1710) $ 25) Administrative Support (CRO -1710) $ $ JAN 12 2021 26) Forgiven Loans (CRO -1440) $ $ 27) 48 -Hour Notice Reports -PTLE C E I V E D (CRO -2220) $ $ 28) Contributions to be Refunded (CRO -1215) $ $ CRO -/100 NC State Board of Elections August 2008 Amendment Aggregated Contributions from Individuals Page I of I ❑ ves ® No Optional 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 e. Amend b. Account Code c. Form of Payment d. In -Kind Description e. Date mm/dd/ C Amount Add Z Electronic 11/03/2020 $ 50.00 Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove Add $ Remove NION COUNTY N FINANCE $ Remove Add ' 2 2021 $ UAdd Remove Add ED $ Remove [3 Add $ Remove Add $ Remove Add $ Remove 4. Total only this Page $ 50.00 5. Total of ALL CRO -1205 Pages (This line must be on line S of Detailed Summary Page CRO -1100) $ 50.00 CRO -1205 NC State Board of Elections April 2007 Amendment Contributions from Individuals Pg I of t ❑ 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 Not employed (Retired) Elizabeth Williams 6623 Mimosa Lane Dallas, TX 75230 c. Employer's Name/Specific Field N/A e. Election Sum to Date $ 900.00 f. Prior g. Account Code It. Form of Payment I. In -Kind Description j. Date (mm/dd/yyyy) It. Amount ❑ Z Electronic 11/16/2020 $ 100.00 ❑ Z Electronic 12/16/2020 $ 100.00 3. Contributor Information ❑ Add ❑ Remove a. Full Name, 9lailing Address & Phone (include city, state, & zip) It. Job Title/Profession d. Comments DAMP CI FINANCE to 12 2021 ENE c. Employer's Name/Specific Field e. Election Sum to Date $ f. Prior g. Account Code It. 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, state, & zip) b. Job Title/Profession d. Comments c. Employer's Name/Specific Field e. Election Sum to Date $ f. Prior g. Account Code It. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) It. Amount ❑ $ ❑ $ 4. Total only this Page $ 200.00 5. Total of ALL CRO -1210 Pages $ 200.00 (This line nuisl be on line 6 of Detailed Summary Page CRO -1100) CRO -1210 NC State [board of Elections April 2007 Amendment Disbursements Pg i of 2 ❑ Yes ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated party 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 fornirs for each tylie of Disbursement. Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Partv Expenditures 4. Payee Information Add El Remove a. Full Name, ))tailing Address & Phone include city, state & zip) b. Coordinated Committee Name d. Comments Facebook 1601 Willow Road Menlo Park, CA 94025 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ Slate ❑ Municipality: e. Election Sum to Date $ 2,608.09 f. Account Code I g. Form of Payment It. Purpose Code i. Date (mm/dd/yyyy) J. Amount it. Required Remarks Z Electronic A 10/192020 $35.00 Facebook ads Z Electronic A 10/20/2020 $50.00 Facebook ads 4.`Payee Information Add El Remove' a. Full Name, Mailing Address & Phone include city, stat & zip) It. Coordinated Committee Name it. Comments Facebook 1601 Willow Road Menlo Park, CA 94025 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ 2,608.09 f. Account Code g. Form orpayment It. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks Z Electronic A 10/23/2020 $75.00 Facebook ads Z Electronic A 10262020 $75.00 Facebook ads 4. Payee Information Add Lj Remove a. Full Name, Mulling Address & Phone include city, state & x1 b. Coordinated Committee Name C' MMoiitti0hF9NANCE JAN 12 2021 Facebook 1601 Willow Road Menlo Park, CA 94025 c. Level Registered (Specify) ❑ Federal ❑ County: FLErFIVFD ❑ State ❑ Municipality: e. Election Sum to Date $ 2,608.09 f. Account Code g. Form of Payment h. Purpose Code i. Date (mm/dd/yyyy) j. Amount it. Required Remarks Z Electronic A 10/28/2020 $11.90 Facebook ads Z Electronic A 11/02./2020 $426.62 Facebook ads 5. Total only this Page S 673.52 6. 'Total of ALL CRO -1310 Pages (This line goes in line l3a of Detailed Sunmmry Page CRO -1100 if Operating Expenses) 1,192.80 (This line goes in line lab of Detailed Summary Page CRO -1100 if Comrib to Candidales/Political Comm) (This line goes in line 13c of Detailed Summary Page CR 0.1100 if Coordinated Party Expenditures) 7. Purpose Codes (List detailed expenditure code in (h.) above) _ A* - Media 11* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses 1 - Postage d - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* - Other * Codes require detailed explanation in required remarks field k /'P/)_ 1711) Mr Clain RnaM of Fbrlinnc nrrrn.l.r. Irmo Amendment Disbursements Pg 2 of 3 ❑ Yes ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated partyex enditures. 1. Committee Full Name and Fund if applicable) 2. ID Number Elect David Williams I MJMVR6 3. Type of Disbursement (Please use senarate CRO -1310 forms for each type ofDishucsentent. ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information Add El Remove a. Full Name, Mailing Address & Phone include ci state &zi b. Coordinated Committee Name d. Comments Facebook 1601 Willow Road Menlo Park, CA 94025 c. Level Registered (Specify) ❑ Federal ❑ County: State Municipality: e. Election Sum to Date $ 2,608.09 f. Account Code g. Form of Payment It. Purpose Code i. Date (mm/dd/yyyy) j. Amount k. Required Remarks Z Electronic A 11/27/2020 $113.10 Facebook ads Z Electronic A 12/01/2020 $79.45 Facebook ads 4. Payee Information Add Remove a. Full Name, Mailing Address & Phone include city, state & z3 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 $ 83.63 f. Account Code g. Form of Payment h. Purpose Code (. Date (mm/dd/yyyy) j. Amount k. Required Remarks Z Electronic O 11/03/2020 $2.30 processing fee Z Electronic O 11/16/2020 $4.30 processing fee 4. Payee Information Add El Remove YN a. Full Name, Mailing Address & Phone include city, stat &zi b. Coordinated Committee Name ommen JAN 12 2021 RECEIVED Anedot 10821 Rosebud Court Baton Rouge, LA 70815 c. Level Registered (Specify) E] Federal 1:1 County: ❑ State ❑ Municipality: e. Election Sum to Date $ 83.63 f. Account Code g. Form of Payment It. Purpose Code i. Date (mm/dd/yyyy) j. Amount It. Required Remarks Z Electronic O 12/16/2020 $4.30 processing fee S 5. Total only this Pae S 203.45 6. Total of ALL CRO -1310 Pages (This line goes in line 13a ojDetailed Summary Page CRO -11001f Operating Fapenses) (This line goes in line 13b ojDetailed Summary Page CRO -1100 iiComrib to Candidates/Political Comm) $ 1,192.80 (This line goes in line 13c ojDetailed Summary Page CRO -1100 if Coordinated Party Fvpenditures) 7. Purpose Codes List detailed expenditure code in above A* - Media R* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Party It* - llolding 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 f'Dn_ t t to ur, a..a.a ,.M—Ii— rl--n ' Onno Amendment Disbursements Pg 3 of f ❑ Yes ® No Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political committees and coordinated oartv ex enditures. 1. Committee Full Name and Fund if applicable) 2. ID Number Elect David Williams I MJMVR6 3. Type of DisbursementPlease use se arate CRO -1310 forms for each type of Disbursement. ® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures 4. Payee Information Add Remove a. Full Name, Mailing Address & Phone include city, state & zip) b. Coordinated Committee Name d. Comments SG Hosting, Inc. 901 N. Pitt Street Suite 325 Alexandria, VA 22314 c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State Municipality: e. Election Sum to Date $ 315.83 f. Account Code g. Form of Payment h. Purpose Code L Date (mm/ddtyyyy) j. Amount k. Required Remarks Z Electronic O 12/14/2020 $315.83 Domain & Hosting fees 4. Payee Information Add Remove a. Full Name, Mailing Address & Phone include city, state i b. Coordinated Committee Name d. Comments CAMPAIGN FINANCE JAN 12 2021 RECEIVED c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State ❑ Municipality: e. Election Sum to Date $ f. Account Code g. Form of Payment h. Purpose Code I. Date (mm/dd/yyyy) J. Amount k. Required Remarks $ $ 4. Payee Information Add El Remove a. Full Name, Mailing Address & Phone include city, state &zi b. Coordinated Committee Name d. Comments c. Level Registered (Specify) ❑ Federal ❑ County: ❑ State Municipality: e. Election Sum to Date L Account Code g. Form of Payment It. Purpose Code L Date (mm/dd/yyyy) j. Amount k. Required Remarks $ $ 5. Total only this Pae $ 315.83 6. Total of ALL CRO -1310 Pages (This line goes in line Hoof Detailed Sunmmry Page CRO -1100 if Operating Expenses) (This line goes in line 13b of Detailed Summary Page CRO -1100 if Contrib to Cmrdidates/Political Conun) (This line goes in line 13e of Delailed Suninuuy Page CRO -1100 if Coordinaled PtuN Expen(litures) $ 1,192.80 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 1 - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund O* - Other * Codes require detailed explanation in required remarks field k) /`F/L /7 /n N/` nn -al IW O