Yanacsek,Robert_2021-Year-endlAme-
Disclosure Report Cover ❑ Yt� at �Na
Use this form for general report and committee information, must be signed and submitted alone with other detailed forms.
Do not a<e Ihi, limn to a xlmc inlurmutinn.
1. Committee Information
a. Full Name
c. ID.\umber
�O i/ .� d G s ��l d2 /1�•�cid
-7 J M .S ? >
. Mailing Address (include City, State and Zip Cade)
S13 s1�
d. Date Ned
It4e, � tiC Z O �� Z
e. Phone Number
7C/ /ZZL
&ReRort Year 3: Period Start Date prurdddtyy) 14. Period End -D_ ate (mm/dd/yy)
15. Treasurer Full Name
�
6 o_f_Conunittee L
9. Type of Report- (check
only one type of r¢port
from one category)
_e
Candidate Campaign ❑ Party
Municipal
State/County
Referendmn
❑ PAC ❑ Referendum
❑ Organizational
❑ Organizational
❑ Organizational
❑ Independent Expenditure ❑ Joint Fundraiser
❑ Thirty-five day
Quarterly
❑ Pre -referendum
❑ Legal Expense Fund
❑ Pre-primary
❑ First
❑ Final
❑ Pre-election
❑ Pre -runoff
❑ Second
❑ Third
❑ Supplemental Final
❑ Annual
%. Type bf Fund _Jfapplicable. check one)
❑ Booster Fund
Semi-annual
❑ Fourth
❑ Special
❑ Building Fund
❑ Other
❑ Mid Year
W, Year End
Final
❑ special
Semi-annual
E3 Mid Year
❑ Year End
❑ Final
10. Special Report Name
8. Number of Fundraisers this Report
-.
❑ Special
11.Account Information
I1. Account Information
. Financial Institution Full Name
a. Financial Institution Full Name
0-N ( v
. Purpose _
c. Account Code
b. Purpose ;v ,v HNC,
c. Account Code
C-�,,�MG�
S /�
tEB 02 2022
it. Period Begin Balance
$EC=IVECi
it. Period Begin Balance
$
CERTIFICATION
1 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 complete, true and corrects and that I have been trained by d C State Board of Elections.
tis
Le 17
Printed Name of Signer Signature of AppointiclTreasurer Date
FOR OFFICE USE ONLY
Date Received: d d �� Employee: Delivery Method
❑ Normal Mail
Registered Mail
Date Postmarked: Employee: Hand Delivered
Date Scanned: �� Employee: [3 Filed
E3
Date Data Entered: Employee: E3 Signer has not received
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.
CRO -1000 NC State Board of Elections August 2009
Detailed Summary
Use this form to summarize all disc loaire [(portio, toll~ and to total monctarc information
1. Committee Full Name (and Fund if applicable)
2. Type of Report
3. ID Number
Start of Election Cycle: January 1, 07
Total this
Re ortin Period
Total this
Election Cycle
4) Cash on Hand at Start
$
$
RECEIPTS
5) Aggregated Contributions from Individuals
6) Contributions from Individuals
7) Contributions from Political Party Committees
S) Contributions from Other Political Committees
9) Loan Proceeds
10) Refunds/Reimbursements to the Committee
11) Other Receipt Sources
Ila) Interest on Bank Accounts
I1b) Contributions from Not -For -Profit Organizations
11 c) Outside Sources of Income
I ld) Legal Expense Fund - Other Sources
I le) Exempt Purchase Price Sales
(CRO -1205)
(CRO -1210)
(CRO -1220)
(CRO -1230)
(CRO -1410)
(CRO -1240)
(CRO -1250)
(CRO -1250)
(CRO -1250)
(CRO -1270)
(CRO -1265)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$$
$
$
$
$
12)TOTAL RECEIPTS (Add lines 5,6,7,8,9,10,1 fa,l lb,l le,l ld and l le)
$
$
C
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 -1315)
(CRO -1420)
(C-RO-1320)
(CRO -1510)
$
$
$
$ . B Q 2 2022
1$
$
$
$
$
$
$
$
$
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$
$
410
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$
$
20) Non -Monetary Gifts Given to Other Committees
(CRO -1330)
$
$
$
$
$
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
5) Administrative Support
6) Forgiven Loans
(CRO -1430)
(CRO -1610)
(CRO -1620)
(CRO -1720)
(CRO -1710)
(CRO -1440)
$
$
$ $
7) 48 -Hoar Notice Reports Sum
28) Contributions to be Refunded
(CRO -2220)
(cttoazts)
$
$
$ $
CRO -1100 NC State Board of Fim ions August 2008