Wilson,Travis_2021-Year-endDisclosure Report Cover Amendment
❑ Yea ® 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 update information
1. Committee Information
a. Full Name
c. m Number
Wilson for Commissioner
062321tw
It. Mailing Address (include City, State and Zip Code)
d. Date Filed
7925 Jaars Rd
Waxhaw, NC
1/30/2021
a Phone Number
28173
980-313-0132
2. Report Year
3. Period Start Date (mm/dd/yy)
mored od End Date
5. Treasurer Full Name
2021
07/01/2021
12/31/2021
Travis Wilson
Chk One
6. T e of Committee ec
9. Type
of Report check onlyone e o re ort rom one category)
Candidate Campaign Party
Municipal
State/County
Referendum
❑ PAC ❑ Referendum
Organizational
El Orgatumtional
Organizational
❑ Independent ❑ Joint Fundraiser
Expenditure
❑
Thirty-five day
Quarterly
❑ Pre -referendum
EjLegal Expense Fond
❑
❑
Pre-primary
Pre-election
❑ Fust
❑ Second
❑ Final
❑ Supplemental Final
7. Typeof Fund (f applicable, check one)
"Booster Fund"
❑ Building Fund
❑
Pre-runoR
❑ Thud
❑ 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
0
11. Account Information
11. Account Information
a. Financial Institution Full Name
a. Financial Institution Full Name
First Citizens Bank
b. Purpose
c. Amount Code
It. Purpose
,
Campaign
1
Operations
J
d. Period Begun Balance
d. erl Begin Balance
$ 40.00
E `,' L- L)
R E$
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. 1 further certify that this report
is complete, true and correct and that I have been trained by the NSC State eBBoard �of Election
Travis Wilson �,�t,n i� �jl_�
01/30/2022
Printed Name of Signer
ignaturc of Appointed Treasurer
Date
FOR OFFICE USE ONLY
Date Received: 3� �--
Employee:Dehve
Method
Normal Mail
Date Postmarked:
�
Date Scanned: a fQ��
Employee:
Employee:
Registered Mail
and Delivered
E] Electronically Filed
❑ Signer has not received
Date Data Entered:
Employee:
mandatory training
Pleese 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.
CRO -1000 NC State Board of Elections August 2008
Detailed Summary
Use this form to summarize all disclosure renortine forms and to total monetary information
Ameadmeat
❑ Yea M No
1. Committee Full Name and Fund if applicable)
2. 15me
of Report
3. ID Number
Wilson for Commissioner
Year End Annual
062321tw
Start of Election Cycle: January 1, 2o2z
Total this
Re rdn Period
Total this
Election Cycle
4
Cash on Hand at Start
$
40.00
$
40.00
RECEIPTS
5) Aggregated Contributions from Individuals (CRO -1205)
6) Contributions from Individuals (CRO -1110)
7) Contributions from Political Party Committees (CRO -1210)
8) Contributions from Other Political Committees (CRO -1230)
9) Loan Proceeds (CRO -1410)
10) Refunds(Reimbursements To the Committee (CRO -1240)
11) Other Receipt Sources
Ila) Interest on Bank Accounts (CRO -1150)
I 1 b) Contributions from Not -for -Profit Organizations (CRO -12S0)
Ile) Outside Sources of Income (CRO -1150)
lid) Legal Expense Fund — Other Sources (CRO -1270)
11 e) Exempt Purchase Price Sales (CRO -1265)
12) TOTAL RECEIPTS (Add Imes 5.6, 7, 8, 9, 10. Ila, 11b, 11c, udand Ile)
$
$
$ 582.00
$
622.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$ 582.00
$
622.00
EXPENDITURES
13) Disbursements
13s) 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
Pn In -Kind Contributions
(CRO -1310)
(CRO -1310)
(CRO -1310)
(CRO -1315)
(CRO -1420)
(CRO -1310)
(CRO -1510)
$ 321.77
$
al.
$
$
$
$
$
$
$
$
$
$
$ 87.00
$
87.00
18)
TOTAL EXPENDITURES (Add lines 13a, 13b. 13c, 14. I5. 16 and 17)
$
408.77
$
,r�(7,
19)
Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18)
$
218.23
$
218.23
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)
(CRO -1430)
(CRO -1610)
(CRO -1610)
(CRO -1720)
(CRO -1710)
(CRO -1440)
(CRO -1210)
(CRO -1215)
$
$
$
$
$
$
$
$
$
$
$
$
$
CRO -1100 NC State Board of Elections August 2009
Contributions from Individuals Pg I of 3 Amendment
❑ 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
Wilson for Commissioner
062321TW
3. Contributor Information L1 Add L1 Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title(Profesaion
d. Comments
Retired
John Blair
5308 Camilla Ln
Waxhaw, NC 28173
704-953-7787
c. Employer's Name/Specific Field
e. Election Sam to Date
$ 50.00
f. Prior
g. Account Code
h. Form of Payment
L lo-Kiod Description
J. Date (mm/dd/yyyy)
it. Amount
❑
I
Electronic
11/16/2021
$ 50.00
❑
$
❑
$
3. Contributor Information LJ Add LJ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & rip)
It. Job TitlelProfesaton
d. Comments
Homemaker
Linda Jones
9425 Hampton Oaks Ln
Charlotte, NC 28270
a Employer's Name/Specific Field
a Election Sum to Date
$ 100.00
L Prior
g. Account Code
h. Form of Payment
L 1n -Kind Description
J. Date (mm/dd/yy")
h. Amount
❑
I
Electronic
11/17/2021
$ 100.00
❑
$
❑
$
3. Contributor Information LJ Add Lj Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profeasion
d. Comments
Business Owner
Kyshia Lineberger
208 Gilead Rd
Huntersville, NC 28078
c. Employer's Name/Specific Field
Concord Children's Academy
e. Election Sam to Date
$ 100.00
f. Prior
g. Account Code
h. Form of Payment
L to -Kind Description
J. Date (mm/ddlyyyy)
it. Amount
❑
1
Electronic
11/17/2021
$ 100.00
❑
$
❑
$
4. Total only this Page $ 250.00
5. Total of ALL CRO -1210 Pages
$ 582.00
(This line must be on rine 6 of Derailed Summary Page CR0.1700J
CRO -1210 NC Slate Board of Elections April 2007
Contributions from Individuals Pg i of 3 Amendment
❑ Yea ® 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
Wilson for Commissioner
062321TW
3. Contributor Information El Add Ll Remove
a. Full Name, Mailing Address & Phone
(include city, sate, & rip)
b. Job Title/Profasion
d. Comments
Grocer
Travis Wilson
7925 Jaars Rd
Waxhaw, NC 28173
a Employer's NamdSpeciilc Field
Food Lion
e. Election Sum to Date
$ 262.00
L Prior
g. Account Code
h. Form of Payment
L la -Kind Description
I. Date (mm/ddlyyyy)
k. Amount
❑
Deposit
9/03/021
$ 60.00
❑
$
❑
$
3. Contributor Information U Add U Remove
a. Full Name, Mailing Address & Phone
(include city, state, & rip)
b. Job Titie7Profession
d. Comments
Grocer
Payment made for filing
Travis Wilson
7925 Jaars Rd
Waxhaw, NC 28173
c. Employees Name/Specific Field
Food Lion
e. Election Sum to Date
$ 262.00
L Prior
g. Account Code
h. Form of Payment
L In -Kind Description
J. Date (mm/ddlyyyy)
k. Amount
❑
Debit
Filing Fee
12/06/2021
$ 87.00
❑
$
3. Contributor Information Add Remove
a. Full Name, Mailing Address & Phone
(include city, sate, & rip)
b. Job Title(Profession
d. Comments
c. Employer's Name/Specific Field
a Election Sum to Date
f. Prior
g. Account Code
h. Form of Payment
L Io-Kiod Description
J. Date (mm/ddlyyyy)
k. Amount
❑
$
4. Total only this Page $ 147.00
5. Total of ALL CRO -1210 Pages $ 582.00
(This line must be on Rne 6 of Demiled Sammory Page CR0.1100)
CRO -1110 NC State Board of Elections April 2007
Contributions from Individuals Pg 2 of 3 Amendment
❑ 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
Wilson for Commissioner
062321TW
3. Contributor Information LJ Add LJ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Title/Profession
d. Comments
Web Designer
Anthony DiPaola
2012 Galena Chase Dr.
Indian Trail, NC 28079
c. Employer's Name/Specific Fleld
Charlotte Interactive
e. Election Sum to Date
$ 10.00
E Prior
g. Account Code
h. Form of Payment
L In -Kind Description
J. Date (mm/ddlyyyy)
k. Amount
❑
1
Electronic
11/19/2021
$ 10.00
❑
$
3. Contributor Information TI Add Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Job Tine/Profesdou
d. Comments
Information Technology
Instructor
Josh Andrews
202 Morgan Cove Rd
Candler, NC 28715
c. Employer's Name/Specific Field
Haywood Community College
e. Election Sum to Date
$ 100.00
L Prior
g. Account Code
h. Form of Payment
L In -Kind Description
J. Date (mm/ddlyyyy)
k. Amount
❑
1
Electronic
12/06/2021
$ 100.00
❑
$
❑
$
3. Contributor Information LJ Add LJ Remove
a. Full Name, Mailing Address & Phone
(include city, state, & rip)
b. Job Title/Profession
d. Comments
Grocer
Travis Wilson
7925 Jaars Rd
Waxhaw, NC 28173
c. Employer's NamdSpecif c Field
Food Lion
e. Election Sum to Date
$ 262.00
f. Prior
g. Account Code
b. Form of Payment
L In -Kind Description
J. Date (mm /ddlyyyy)
it. Amount
1
Deposit
12/06/2021
$ 75.00
❑
g
4. Total only this Page $ 185.00
5. Total of ALL CRO -1210 Pages $ 582.00
(This line must be on line 6 ofDemifed Summary Page CRO -1100)
CRO -1210 NC State Board of Elections April 2007
In -Kind Contributions Pg of I Amendment
❑ Yea ® No
Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund.
Use URU-121) it m-&md Uontnbutlons were or will De retuned Wtmm / clays.
1. Committee Full Name and Fund if applicable) 2. ID Number
Wilson for Commissioner 062321TW
3. Contributor Information U Add 1 11 move
a. Full Name, Mailing Address & Phone
(include city, state, & rip)
b. Type of Contributor
c. Comments
DQ
❑
❑
❑
❑
❑
Individual
Candidate
Party
PAC
Referendum
Other Receipt Source
Filing fee paid
as in kind
contribution
Travis Wilson
7925 Jaars Rd
Waxhaw, NC 28173
d. Election Sum to Date
$ 262.00
e. Description
L Date (mm/dd/yyyy)
g. Fair Market Amount
Filing fee paid from personal account as in-kind
12/06/2021
$ 87.00
$
3. Contributor Information Ll Add LL11 move
a. Full Name, Mailing Address & Phone
(include city, state, & rip)
b. Type of Contributor
c. Comments
❑
❑
❑
❑
❑
Individual
Candidate
Party
PAC
Refercndum
Other Receipt Some
d. Election Sum to Date
$
e. Description
E Date (mm/dd/yyyy)
g. Fav Market Amount
$
$
3. Contributor Information Lj Add I III emove
a. Full Name, Mailing Address & Phone
(Include city, state, & sip)
b. Type of Contributor
c. Comments
Lj
❑
❑
❑
❑
❑
Individual
Candidate
Party
PAC
Referendum
Othcr Receipt Source
d. Election Sum to Date
$
e. Description
L Date (mm/dd/yyyy)
g. Fav Market Amount
$
15. Total of ALL CRO -1510 Pages I
(This fine meet be on fine 17 of Detailed Summary Page CRO -1100) $ 87.00
;RO-1510 NC State Board of Elections December 20(
Disbursements Ps Of Amendment
❑ Yes ® No
Use this form to report expenditures from the committee for, operating expenses, contributions to candidate/political
committees and coordinated Darty exnenditures.
1. Committee Full Name and Fund if applicable) 2. ID Number
Wilson for Commissioner I 062321TW
o rseanent.
3. T e of Disbursement Please use separate CRO -1310 forms or each Dubu
Operating Expenses Contributions to Candidates/Political Committees Coordinated Patty Expenditures
4. Payee Information Add Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Coordinated Committee Name
d. Comments
First Citizen Bank
111 E Jefferson St
Monroe, NC
28112
1 (888) 3234732
28112
e. Level Registered (Specify)
Federal County:
State Municipality:
a Election Som to Date
$ 25.00
f. Account Code
g. Farm of Payment
h. Purpose Code
L Date (mm/dd/yyyy)
J. Amount
k. Required Remarks
I
Electronic
O
08/31/2021
$25.00
Recurring $5
Service fee
I
to 12/31/21
$
4. Payee Information Add Lj Remove
a. Fall Name, Mailing Address & Phone
(include city, state, & zip)
b. Coordinated Committee Name
d. Comments
SG Hosting Inc
901 N. Pitt St, Suite 325
Alexandria, 22314 VA
1-800-828-9231
c. level Registered (Specify)
Lj Federal 0 Comity:
State Municipality:
a Election Sum to Date
$ 65.87
L Account Code
g. Form of Payment
h. Purpose Code
L Date (mmlddlyyyy)
J. Amount
k. Required Remarks
A
$65.87
Web Hosting
Payment
4. Payee Information I Add Remove
a. Full Name, Mulling Address & Phone
(include city, state, & zip)
b. Coordinated Committee Name
d. Comments
Anedot
5555 HILTON AVE SUITE 106
BATON ROUGE LA 70808
225-250-1301
a Level Registered (Specify)
Lj Federal M County:
El State 0 Municipality:
e. Election Sum to Date
$ 15.90
L Account Code
g. Form of Payment
h. Purpose Cade
i. Date (mmlddlyyyy)
J. Amount
k. Required Remarks
1
Electronic
C
11/18/2021
$2.30
DonationProcessing Fee
1 Electronic C 11/22/2021 $8.60 DonationProcessing Fee
5. Total only this Pae $ 106.77
6. Total of ALL CRO -1310 Pages
(This line goes in line 13a of Detailed Summary Page CRO -1100 ifOperasing Expenses)
(This line goes in line 13b ofDemiled Summary Page CRO -1100 if Contrib to Candidates/Pohrical Comm) $ 321.77
(This lfnegoes in hne 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 Party H* - Holding Public Office Expenses
I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* - Other
* Codes require detailed explanation in required remarks field k
CRO -1310 NC State Board of Elections December 2009
Disbursements Pg of Amendment
❑ 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) —21D Number
Wilson for Commissioner 062321TW
3. T e of Disbursement
Please use separate CRD -1310 forms or each of Disbursement
Operating Expenses
Contributions to Candidates/Political Committees Coordinated Party Expenditures
4. Payee Information Lj Add M Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Coordinated Committee Name
d. Comments
Anedot
5555 HILTON AVE SUITE 106
BATON ROUGE LA 70808
225-250-1301
c. Level Registered (Specify)
Lj Federa County:
State Municipality:
e. Election Sum to Date
$ 5.00
E Account Code
g. Form of Payment
h. Purpose Code
L Date (mm/ddlyyyy)
j. Amount
it. Required Remarks
I
Electronic
C
11/23/2021
$0.70
Donation
Processing Fee
I
Electronic
C
12/08/2021
$4.30
DonationProcessing Fee
4. Payee Information Add Lj Remove
a. Full Name, Mailing Address & Phone
(include city, state,& zip)
b. Coordinated Committee Name
d. Comments
WIXE Radio
1700 Buena Vsta Road
Monroe, NC 28112
(704) 289-2525
c. Level Registered (Specify)
Lj Fedeml M County:
State El Municipality:
e. Election Sum to Date
$ 210.00
f. Account Code
I g. Form of Payment
It. Purpose Code
L Date (mmlddlyyyy)
J. Amount
it. Required Remarks
I
Debit
A
12/06/2021
$210.00
Radio Ads
$
4. Payee Information Add Lj Remove
a. Full Name, Mailing Address & Phone
(include city, state, & zip)
b. Coordinated Committee Name
d. Comments
c. Level Registered (Specify)
Lj Federal Comty:
State Municipality:
e. Election Sum to Date
$
L Account Code
g. Form of Payment
h. Purpose Code
i. Date (mm/ddlyyyy)
J. Amount
it. Required Remarks
5. Total only this Pae $ 215.00
6. Total of ALL CRO -1310 Pages
(This fine goes in line 13a of DendledSummwy Page CRO -1100 if Operating Expenses)
(This line goes in line 13b of DeraikdSummmy Page CRO -1100 if Conlrib to Candidmes/PoWcal Comm) $ 321.77
(This fine goes in line 13c of DeaRed Summary Page CRO -1100 ifCmrdinmed 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 Party H* - Holding Public Office Expenses
I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund
O* - Other
* Codes require detailed explanation in required remarks field k
CRO -1310 NC State Board of Elections December 2009