Williams,David_2021-Year-endAmendment
Disclosure Report Cover I ❑ 1'es ® 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 it date 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
01/27/2022
Indian Trail, NC 28079
e. Phone Numhcr
980-328-4408
2. Report Year
3. Period Start Date (mm/dd/yy)
4. Period End Date
GnmWdhr
5. Treasurer Full Name
2021
7/1/2021
12/31/2021
David H. Williams
6. Type of Committee (Check One)
9. TV pe of Repo rt check onl , one t ,pe'bfre ort from one calegortl
Candidate Campaign ❑ Pany
Municipal
Stale/Count),
Referendum
❑ Organizational
❑ Organizational
❑ Oreanizolinnal
❑ PAC ❑ Referendum
Independent
El Expenditure E] Joint Fundraiser
❑ Thirtr-five day
Quarterly
❑ Pre -referendum
Legal Expense Fund
E]Pre-primary❑
❑ Pre-election
First
❑ Second
❑ Final
❑ Supplemental Final
7. Type of Fund (ii applicable. check one)
❑ "Booster Fund'
❑ Building Fund
❑ Pre -runoff
Semi-annual
❑ Third
❑ Fourth
❑ Annual
❑ Special
❑ Mid Year
Semi-annual
10. Special Report Name
❑ Other:
❑ Year End
❑ Mid Year
❑ Final
❑ Special
® Year End
❑ Final
❑ Special
8. Number of Fundraisers this Report
None
11. Account Information 11. Account Information
a. Financial Institution Full Name a. Financial Institution Full Name
BB&T (n/k/a Truist)
b. Purpose
C. Account Code b. Purpose
c. Account Code
Campaign
donations &
Z
d. Period Begin Balance
expenditures
d. Period Begin Balance
S 1301.66
$
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 INC 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 St a Boar of Elections. '
David H. Williams
Printed Name of Signer Signatu a of Ap romled Treasurer Date
FOR OFFICE USE ONLY
Delivery Method
Date Received: t� d i� Employee:
❑ Normal Mail
Date Postmarked: Employee: ❑ Registered Mail
11and Delivered
Date Scanned: �a' Employee: ❑ Electronically Filed
UNICOCO&4+ N has not received
Date Data Entered: Employee: CAMPAIGN RNdd Wd l training
Please Note: This form cannot be used to amend committee information such as the committee a dress, 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 -W)- IWilt N(' Cmte Rna.rl nr 1141R
Amendment
Detailed Summary ❑ ves ® No
rPnnrtino fnrmc and to total monetary information.
1. Committee Fall Name and Fund if applicable)
2. Type of Report
3. ID Number
Elect David Williams
Year End Semi-annual
MJMVR6
Start of Election Cycle- January 1, 2017
Total this
Report , Period
Total this
Election Cccle
4)
Cash on Hand at Start
$
1 ,I) I oo
$
(wo
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
II) Other Receipt Sources
I la) Interest on Bank Accounts
1 Ib) Contributions from Not -for -Profit Organizations
1 le) Outside Sources of Income
Ild) Legal Expense Fund — Other Sources
11 e) Exempt Purchase Price Sales
(CRO -120.5)
(CRO -1210)
(CR04210)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
(CRO -12.10)
(CRO -1150)
(CRO -1270)
(CRO -126.5)
$
h
130.20
$
$
9577.25
$
$
$
$
18434
$
$
$
$
$
$
$
$
$
$
$
$
$
$
12)
TOTAL RECEIPTS ( Idd Imes 5i 6_ , S 9 ur_ 110 nn uc 10,11111110
$
o.0o
$
9891.79
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)
(CRO -1310)
(CRO -1310)
(CRO -131.5)
(CRO -1420)
(CRO -1320)
(CRO -1510)
$ 317.87
$
8771 1 i
$
$
$
$
$
$
$
$
$
$
$
$
136.85
18)
TOTAL EXPENDITURES Odd lines /3a, 136, 13c. 14. 15,16 and 111
$
317.87
$
8908.00
19)
Cash on Hand at End Odd lints 4 and 12 together. then suhtrad line 18)
$
983.79
$
983.79
ADDITIONAL INFORMATION
20) Nou-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 -I.;;0)
(CRO -1430)
/CRO -1610)
(CRO -1620)
(CRO -1720)
(CRO -Ino)
(CRO -1440)
(CRO -2220)
(CRO -1215)
$
$
$
$
$
$ CAMP,°1",$-
$ lAbL?$/
2079
$
$
$
CRO -1100 NC State Board of Elections August 2018
Amendment
Disbursements Pg j of I ❑ sec ® No
Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political
..A A; tnA ,...,nr a ndi!ures
w;""Ml. CS unv wmv.......... .... -.. -..�.. _. -.,.
I. Committee Full Name (and Fund if applicable) 2. ID Number
Elect David Williams MJMVR6
3. Type of Disbursement Please rt.se se Orale CRO -1310 Lorlits Lor each type o Disbur.(etnent.
Operating Exlxnses ❑ Connihmiom to Candidates'Poliical Committees ❑ Coordinated Pani Espandlnaes
4. Pavice Information Add Remove
a. Frill Name, Mailing Address & Phone
(include city, state, & zip)
Is. Coordinated Conuninee Name
d. Comments
Site Ground Hosting, Inc.
901 N. Pitt Street
Suite 325
Alexandria, VA 22314
c. Level Registered (Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality:
e. Election Sum to Date
$ 633.70
I'. Account Code
g. Farm of Payment
Is. Purpose Code
t. Date (mm/ddlyyyy)
j. Amount
k. Required Retain ks
Z
Electronic
O
12/13/2021
$317.87
Domain &
Hosting fees
4. Pavice Information R Add Lj Remove
it. Full Name. Mailing Address & Phone
include circ, state. & zip)
1. Coordinated C'onunince Name
d. Comments
c. Level Registered (Specify)
❑ Federal ❑ County:
State ❑ Municipality:
e. Election Stint to Date
$
f. Account Code
g. Form of Payment
h. Purpose Code
i. Dale (mm/dd/yyyy)
j. Amount
k. Required Remarks
$
$
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 El Municipality:
e. Election Sunt to Date
$
f. Account Cole
g. Form o(Paynnent
h. Purpose Code
i. Date (mm/dd/) t
j. Amount
k. Required Remarks
$
$
5. Total only this Pane $ 317.87
6. Total of ALL CRO -1310 Pages
(This line goes in line Ma of Detailed Sunnn ity Page CRO -1100 if Operating F%penses) 17 7
(This line goes in line I.tb of Detailed Sttnumt{)• Pnge CRO -1100 if Contrib to CandidatesiPolifical ComnO
(This line goes in line l.te of Betniled Sanannrr Page CRO -1100 i(Cnordinated Ports' Erpendimres)
7 Purpose Codes (List detailed expenditure code in (h) above)
A^ - Media B* - Printing C* - Fundraising D - To Another C;mdidate
E - Salaries F* - Equipment C - Political Party H* - IloldingtPublic Office Fxpen.ws.
1 - Postage J - Penalties IC* - Office Expenses Q* - Donatiop fo Legal Expense Fund
O* - Other
* Codes require detailed explanation in required remarks field (k)
!W /L r 2 fit IJ!' Cr rr R., —1 „r rI— I..'— F), .—I". L u kr