Williams,David_2021-MidYearAmendment
Disclosure Report Cover ❑ Yes ® No
Use this form for general report and committee information, must be signed and submitted along with other detailed forms.
Dn not use this frim to unrlate 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
7/14/2021
Indian Trail, NC 28079
e. Phone Number
980-328-44084 ITN
2. Report Year
3. Period Start Date (mm/dd/yy)
4. Period End Date
mm/dd/v
5. Treasurer Full Name
David H. Williams
2021
01/01/2021
06/30/2021
6. Type of Committee Check One
9. Type
of Report check on one tvve o re ort in one category)
® Candidate Campaign ❑ Party
Municipal
State/County
Referendum
❑
Organizational
❑ Organizational
❑ Organizational
❑ PAC ❑ Referendum
Independent ❑ Joint Fundraiser
❑ Expenditure
❑
Thiny-five day
Quarterly
❑ Pre -referendum
Legal Expense Fund
❑
❑
Pre-primary
Preelection
❑ First
❑ Second
❑ Final
❑ Supplemental Final
7. Type of Fund (iapplicable. 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 Report Name
❑
❑
Final
Special
❑ Year End
❑ Final
❑ Special
8. Number of Fundraisers this Report
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
BB&T
b. Purpose
c. Account Code
N1011 COUNTY
b. Purpos tAMPAIGN I=jNl41CT=
c. Account Code
Campaign
donations &
Z
JUL 1 4 2021
d. Period Begin Balance
it. Period Begin Balance
expenditures
S 1301.66
s
RECEIVED
CERTIFICATION
I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B, & 22D -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
David H. Williams
by theNC S to Board o Elec 'ol
Printed Name of Signer
Signature of Appinted Treasurer Date
FOR OFFICE USE ONLY
Date Received: la--
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 -2100A -E to make committee changes.
f'R/L //1011 mr Rime Rnant of Fleefinnc Anvuci Irma
Amendment
Detailed Summary ❑ les ® No
Use this form to summarize all disclosure re ortinu, forms and to total monetary information.
1. Committee Full Name (and Fund if applicable)
2. 'VV
pe of Report
3. ID Number
Elect David Williams
Mid -Year Semi-annual
MJMVR6
Start of Election Cycle: January 1, 2021
Total this
Reporting Period
Total ntis
Election ('cele
4)
Cash on Hand at Start
S
1301.66
$
13, 01.06
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
I la) Interest on Bank Accounts
I Ib) Contributions from Not -for -Profit Organizations
lc) Outside Sources of Income
IId) Legal Expense Fund - Other Sources
11 e) Exempt Purchase Price Sales
(CRO -1105)
(CRO -1110)
(CRO -1120)
(CRO -1230)
(CRO -1410)
(CRO -1140)
(CRO -1150)
(CRO -1250)
(CRO -1150)
(CRO -1270)
(CRO -1165)
$ 0.00 $
0.00
$ 0.00 $
0.00
$ 0.00 $
0.00
$ 0.00 $
0.00
$ 0.00 $
0.00
$ 0.00 $
$ 0.00 $
0.00
0.00
$ 0.00 $
0.00
$ 0.00 $
0.00
$ 0.00 $
0.00
$ 0.00 $
0.00
12)
TOTAL RECEIPTS (Add lures 5 6 ' 8, 9, 10 1&, 1/1, 11,_ 1ldand Ile)
$
0.00
X
0.00
EXPENDITURES
13) Disbursements
13a) Operating Expenditures
13b) Contributions to Candidates/Political Committees
13c) Coordinated Party Expenditures
14) Aggregated Non -Media Expenditures
15) Loan Repayments
16) Refunds/Reimbursements From the Committee
17) In -Kind Contributions
(CRO -1310)
(CR04310)
(CRO -1310)
(CRO -1315)
(CRO -1420)
(CRO -1310)
(CRO -1510)
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
$ 0.00
$
0.00
18)
TOTAL EXPENDITURES (ddd Hees 13a, 13b. 13c. 14. 15. 16 and 171
$
0.00
$
0.00
19)
CASA on Hand at End (Add lines 4 rmd 11 together, rhea .subunel Hne 18)
$
1301.66
$
1301.66
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 -1.130)
(CRO -1430)
(CRO -1610)
(CRO -1620)
(CRO -1720)
(CRO -1710)
(CRO -1440)
(CRO -1220)
(CRO -1215)
LINT",
$ CAMPV 'I FINANCE
$
$
$
$
$ $
$ $
$ r
$
CRO -1100 NC State Board of Elections a11111,t 'tn,x