Wortman 2016 Fourth Quarter Reports. Fnll Nrm.c, lD Numbcr
COMMITTEE TO ELECT DAVID WORTMAN
- ^Fr\ rEn FHA-l-W-4
M.iliDg Add'tss (ioclEdc Cit!', Strtc .!d Zp Codo)d. Drt. tril.d
Hc Bd'
I
BREANNA CAMPBELL2016t0t23/2016 t2/3v2016
JAN 1' 2011
of EEdions
0yt0/20t7
c. Pbole Nu mbcr
2236 ACACIA DRIVE
WI[.I\4INGTON, NC 28403
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BRANCH BANKING AND TRUST COMPAI.{Y PIRYX, INC, DBA RALLY.ORG
b. Pu rprrs.c Accornl Cod.b. Pu rposc r. Accol!trt Codc
DWORTMANIS DWORTMANI4
d. P.riod Bcpio B.lrnc.d- P.riod B.gitr Brl.n..
CAMPAIGN
CONTRIBUTIONS
3,704.3s,r/$
ONLINE CONTRIBUTIONS
$
CBIIFICATION
I certiry that the Crrrnittee or Fund is in conpliance with all applicable provis ions of Article 22A, 228 & DDZAtl of
Chapter 163 ofthe NC Getrersl Starutes and thst no funds arc cormbgl€d rvith prohibited or other non{isclosed
funds. I funhercediry that this report is couplete, true aod corlcct and tbat I have been
Dateaturc o Appointed
ed by th€ NC State Board
bdt 0l/10/2017
Print^(\L
Tt}ROFTETBEONLY
Date Rec€ived:
Date PostMr*rd:
Dat€ Sosnn€d:
Date Data Enter€d:
Frpbyee:
Erployee:
Blployee:
Enptoyee:
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! Signer has not received
rnEndatory training
Nornal Mail
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Plcase Note : T'his form cannot be used to anpnd cormittee infonmtion such as the connittee address, treasurer,
assistant tr€asurEr, custodian of books infor[Dtion, oraccount infomation,
You rrust arEnd the StaterEnt of OrEaniztioo (CRG2Io0A-E) to EB&e comdttee chanses.
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use this form for general report and conmittee mtonrntion, nuiTEl!!ffind*uffired
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cR(L1000 NC Sate Rlections Dccem 2007
10. Srcid
l. Committee trtll Nrme (slld trtnd if epdicaHe)2. 'l}pe ofReport 3. ID Nunrbr
COMMITTEE TO ELECT DAVID WORTMAN 20'16 Fourth Quarter FHA-I-W4
Start of Election Clcle: Januery 1, j9ll Totrl this
Electiotr CYcle
Totrl this
Reprliag Pcriod
5) Aggregeted Corlrihutioos from trndviddc
6) CotrtdbutioB frolB lndiridrdg
7) Coltrihtiom from Politicrl Plrty Committ€cr
t) Contrihtions FoE Olter Politicrl Committ cs
3,704.354) C8sh on tlrd st Strrt
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$I 66
$B
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7,5
t2s0)lla) htcrestoll BaDk Accouols
4,66
0.00
0.00
0,00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
(act20t)
(cRG12r0)
KAO1220)
(cRot230)
(ao-t1t0)
(cn&t210)
(aoI270)
(aat26s)
9) Loo Procee&
0) Refu a&/Reimhrrserrnts
l) Other Receipa Sources
.fiEfiAtvED
JAN 12 ?11'l
Gna12s0)
(caal2s0)I lc) Outside Sourcos ofI[come
llO Irgsl Erpemc Fbod- Otber Sorrces
l le) Eio[pt Purch$e Pricc Sdei
I lb) Cotrtrihdolts ftom
s / 4.66 s 32t&Kt2) TOtfAL REEIPTS (Add lines 5' 6, 7' 8' 9,10,1 la,l lb,l lc,l ld ard I le)
3,088.72$l05
0.00$0.00s
0.00$0.00$
tg6N$r 78.00s
0.00$0.00$
0.00$0.00$F$4.66$
l3r) OFrrtiDt &Ftrdhrci
l3b) Contrihliols to Cudd.t$/Polilicd CoDDittces
l3c) Cmrdnded Prrty ftFndtures
4) Aagreglt€d Noo-ll&de Epodturcs
(aol3I0)
(aot3t0)
(cRGr 3l0)
(aGl3tS)
(cRot120)
(ao-1320)
(aor 0)
5) I,t[ R.Fynetrrs
6) Refun&/Reimhtrsenre trts from thc Committce
7) ln.lGod Cootri htions
) Disborsemeots
DITTJR.ES
$,,/ z.ztr.tt $Iwyr{lE) TOTAL D(PE\DlflJnES (Add tines l3a' l3b' I 3c, ld 15, 16 ud 17)
C-8s h oo ILnd .t hd (Add lin€s 4 and I 2 togdhq, theo subtracl line I 8)
0) Notr-lvlorctsry Gifo Giten to Other Committccs
l) Outstrulng Lmtrs (itrcl. o[cs from other clmFigtrs)
2) Detts etrd OHigetions oned by tbc Commitlee
43't .6343',1 .63 $S
$
$
$
$
$
$$
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e)
INFORMATIOND
Gnot330)
Gno,1130)
(cno-t610)
(cRGt620)Deh rnd OHigations olred to the Committee
(cRct720)4) Accou[t Trrtrsfers Witbiu tbe Committce
(cRo- l7 t 0)
Gnot110)
(cRo-2220)
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5) Afuioistntitr Strpra
6) ForgilEE t oDr
7) 4t-Ibor Notice Rcporb Sum
0.00$0.00$(cno-t2r 5)18) Contribudoos lo be Refrrtrded
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Detailed Summary
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Aggregated Contribufions from Individuals prgc l or r H'JI'"L rr"
form used to report NC Contributbns From Indiviluab of$50 or hss
t/
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RECEIVED
JAN l2 2017
NHC Bd. of Etections
FHA-l-W4COMMITTEE TO ELECT DAVID WORTMAN
Afi.nd b. Aacoool Codc c. ForD of Payoadt .. Drtc (lr D/ddryyyy)f. Ao ooot
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In-Kind MAIL POSTAGE t0r29n0t6 4.66$
4. Total only this Page $4.66$
5. Total of AII CRGI205 Peges
(fhb laz ,nt,a bc on dr. 5 of ltdoAcd Sun fiary Pagc AAI100)s4.66s
2. ID Numlrcr
3. Cortrihrtor ln fortnrtion
ld. tr-Krd D.r.ripaio.
COMMITTEE TO ELECT DAVID WORTMAN
Contrihniorsto Can didat.s,Po lit icil Commitlees crordinated Pany ExpeDdillrcsEx
b- Coordinrlcd Cotn 6iltca Ntmr d- Com trrantsa. Full NarE, Mailirg Addrcss & Phone
(iocludc city, 3trt., & zip)
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E Fc&ral
E gat.I cornty:
I urnlcipet;ry e. Ecctioo SUD to DrtG
/got.tz$
CLAMWORKS CO.
22OI BEL ARBOR
WILMINGTON, NC 28403
k. Reqoircd Rem.rkst, Purporc Coda i, D.tc (In m/ddltyyy)j. AD ourrf. AccorI!t Cod.g. ForD of Prym.Dt
I 2,763.7?AD PURCHASECheckI l5Dot6DWORTMANI
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d. Com m. n tsb. Coordi!rtsd Cont lrtitlce Nrmaa. Full Narr, Mailing Address & Phone
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c. Lvcl Rcgill.red (S p..i fy)
e. Electiotr Sum lo DatrEl sat"
Federal I coraty:
E Urn;"ipaity
75.00,$
RAYA EAGON
233 RACINE DRIVE
LTNIT 33
MLMINGTON, NC 26403
L, Rrquircd Rcmrrksj, ADo$!lh, Pu rpos. Cod.i. DttG (& o/dd/yyyy)f. Account Coda g. Form of Pryoatrl
$ 75.00tv08Dot6CheckIt/DWORTMAN I
$
d. Com mctr tsb. Coorditrstcd Coomillaa Nrmea. Full Nanr, Mailing AddrEss & Phone
(itrclod. clty, !t a., & zip)
.. Lrrl Rcgiil.rcd (Spccify)
e. trIcctioo SurD to llrte
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E $"r"
I courty:
I t'tunicipatity
75.00$
DEREKEMME
32I HOOKER ROAD
MLMINGTON, NC 2t403
j. Aooort k. R.quircd RcmrrLsh. Porpolc Codc i. Dit. (6d/d(Vyyyy)B, Form of Payoaotf. Accouot Coda
$ 75.00EI I /08/2016CheckDWOR'I'MANI
$
2,913.72$I -a
3,088.72$(Thb lta. p.t ln tlne l3a o! Derotlcd &,rirnrq PoSc C1AI100 lf OP.ratlag ErcP.ns.s)
(TbB ltn 9o.5 ia llaz ,3b otDdalkd SLtnmary Pogc (AO-1r00 {Corrfrlb lo C'andldctdPol Xal C.mn )
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A' - Illede
E - Salaries
I - Postage
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B* - Prindrg
f* - E4qiFD€nt
J - Penalties
Ct - tbadreiring D-To Aoother Candidate
G - Political Party H' - Holdng PuHic ofEce Expetr8€s
K* - Of6ce &penses Q* - Ilooatior to lrgal &Ftrse Fhnd
r Codes reqri re detailed erdrmtio[ itr reqrired rcmerks field(k)
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ArD cn dD. tr IDisbursements pc 2 or -l_ E vcr E no
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conmittees and coordinated
310
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Re"Ell:
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COMMITTEE TO ELECT DAVID WORTMAN
cootrihriotrs to caodiddtcJPoliticd cofi mittees
b. Coorditrrt.d ComEittea N.6a d. CoE 0ctrts
Coordinated
Et Li
I uuricipality,e. f,laation Sum lo Date
Full Nanr, Mailing Address & Phone
n.luda
c. Lv.l R.girl.red (Spccify)
I sarc
$75.00
MADELINE ESTEP
32I3 SNOWBERRY COURT
WLMINGTON, NC 28409
k. Raquir.d Rctrrrrk,h. Purporc Cod.i. D.r. (D d/dd/yyyy)j. AmouDlf- Accourl Cod.g. Form of PryD.Dt
E lv0El20t6 $ 75.00rDWOR'I'MANI Check
d. Con m.tr lBb. Coordirrt.d CoDailtcc
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(s
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Narrc, Mailing Address & Phone
udc &zi
c- l-cvrl Re
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100.00$
MERYL ESTEP
3213 SNOWBERRY COURT
MLMINGTON, NC 28409
k. Raquircd Rcmlrksi.Ir.lt (BD/dd/yyyy)j. AInouDap, Form oI PayrBent h. Purposa Codaf- Accorrt Codc
$ 100.00"Check E tll08l20t6DWORTMANI
$
175_00$
(Thit lti. pa tn linc t 3a of Derolled Sr,mrnory PoE CRAI100 tfoP.tutlng
(Thb ttac go.t ht lhv t 3b olDdo cd S$ra,,c,y PoE CRO'I100 ttco$rrib lo Candd.lad?otui.ol Cor,,Dt)
3,088.72$Expe^ses)
(Thh ltn. gocs tn tine l3c ofDclsikd Srn rrory Pog. CRO-|100 tlCootdl@red PsO Expendtturd)
Olhcr
D - To Another Candidategr - Iloldlrt Puuic OfEce ElFnEeo
Q* - Dolatioo to Legsl SQense FuDd
Cr - trtndrrising
G - Political Paty
K* - Offce Elpenres
B* - PritrtiDg
I* - &oiFEnt
J - Penalties
* - ll&dr- Salaties- Post8ge
ID Numter- Committe c rrut-l-w-+
3. T]?e of DiEb.t13emetrt
Add Rermve
4.E
tr
5. Tolrl otrly ltis Pagc
Total of ALLCRGI3I0 Prges
7. Pu4)ose Codes (L.ist detailed ependiture code in t'h.) above)
* Co&s
F---t
COMMITTEE TO ELECT DAVID WORTMAN FHA-l-W-4
El Add
I Remove
DWORTMANI ]Draft t)tt/2tDot6 $ 4.00 BANK ACCOUNT
SERVICE CHARGE
E Add
ft Rcmo""t2t2v20t6 BANK ACCOI'NT
SERVICE CHARGIi
DWORTMAN I3 Draff o $ 4.00
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DWORTMANI3 Check E |Llt4D0l6 s 30_00
tUt4/20t6 $ 30.00E Add
I ncmo"e
Check E
'I llt4lz0t6 $ 20.00E] A&
I Rcmovc
DWORTMANI3 Check E
t t/07/2016 $ 30.00El Add
f] Rcmove
DWORTM NI3 Check E
ty t4D016 $ 30.00E Add
I Re.u"e
DWORTMANI3 Check D
$ 30.00DWORTMAN I3 Chcck D 1v07n016fJ Add
f] Removc
t 7E.00$
178.00
D - To Amther Candifute
G - PolitbalE - Sahries
s
Q* - Donrtions to Legel ExpcnseJ - Penaltbs
* Codes rrouire detailed erplanation in required r€(e)
Aggregated Non-Media Expenditures
form used to NC Non-Media
3tt
Amendment
Prgc -.-l of I , E Yes B l.,to
of $50 or less.
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3. Payee luformrtiou
lr. Ac€ount Cod.Ameod lc. ForD ofP.yltGtrt Codr r- Irrt. (E d/dd/yy]ry)lf. amono t g, Rcquircd RcEarks
4. Total only this Pege
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(Thb li@nasr le on ude 11 of Ddailad Sur'n ary Pogc CnO-r 100)
Total of ALL CRG1315 Pagcs
H* - floldins Public Olfice ExpcnsesclltIEr
Kr - Offcc Er ciscs
O* - Other
DWORTMANI3
AIc trdD cn tIn-Kind Contributions ps I or I E y.. E no
Use this form to report non-trDrdary contdbutioDs, dondions, goods or services providrd to thc commiu€e or finld.
Use CRGl215 were or will be within 7
5t0
t/
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COMMITTEE TO ELECT DAVID WORTMAN
trull NrDe, Mrilitrg Addre$ & Pho!.
(ioclud! city, ra.t., & zip)
b. 'IYpe of otrtribotot
lndiv idual
Aggregated Individual Contribution fl caaaaate
E p"ny
E PAc
E Referetr&m
E Othcr RGGsipt Souc.
FHA-l-W-4
c. ComtD Gnts
d. E..tioo Su@ ao Drac
$4.66
a. Dascrlption t D.rc (E d/dd,/yyyy)g. Pair Mrrlar AEolrtrt
MAIL POS'I'AGE 10129D0t6 $4.66
$
$
$4.66
$4.66
E3. Cootrihtor lnformation I Add E Rcnnve
4. Totel only thh Page
5. Total of ALL CRO-1510 Pages
l7:hiJ li6e 6ug b. on linc l7 of Derolled Surnrn04' PoF CRO-l Ilr0)