MacNeish 3rd Quarter Report Amendment Amendment
Disclosure Report Cover Yes ❑ 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.ID Number
Jennifer Hardison MacNeish for ROD 8HA5LL
b.Mailing Address(include City,State and Zip Code) d.Date Filed
616 Southerland Farm Rd. 12/17/2012
Wilmington,NC 28411 e.Phone Number
910-538-2083
2.Report Year 3.Period Start Date(mm/dd/yy) 4.Period End Date 5.Treasurer Full Name
(mm/dd/yy)
2012 07/01/2012 10/20/2012 Lisa R. Sherrill
6.Type of Committee(Check One) 9.Type of Report (check only one type of report from one category)
® Candidate Campaign ❑ Party Municipal State/County Referendum
❑ PAC ❑ Referendum ❑ Organizational ❑ Organizational ❑ Organizational
Independent Joint Fundraiser Thirty-five da
❑ Expenditure ❑ ❑ rtY' Y Quarterly ❑ Pre-referendum
❑ Legal Expense Fund
7.Type of Fund (if applicable,check one) ❑ Pre-primary ❑ First ❑ F• inal
❑ "Booster Fund" ❑ Pre-election ® Second ❑ Supplemental Final
❑ Building Fund ❑ Pre-runoff Third ❑ Annual
Semi-annual Fourth ❑ S• pecial
❑ Mid Year Semi-annual
❑ Other: ❑ Year End ❑ Mid Year 10.Special Report Name
❑ Final ❑ Year End
8.Number of Fundraisers this Report ❑ Special ❑ Final
0 ❑ Special
11.Account Information 11.Account Information
a.Financial Institution Full Name a.Financial Institution Full Name
First Citizen
b.Purpose c.Account Code b.Purpose c.Account Code
Campaign BW DEC 19 20a
d.Period Begin Balance( 6 d.Period Begin Balance
$ $
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 prohi,t#,-d 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 S Boar. . - ti,ns.
Printed Name of Signer 11V ature of App•'.ted Treasurer Date
FOR OFFICE USE ONLY
Date Received: (Y Employee: / �..� ,
r. 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.
CR0-1000 NC State Board of Elections August 2008
Amendment
Detailed Summary ® Yes 0 No
Use this form to summarize all disclosure reporting forms and to total monetary information.
1.Committee Full Name(and Fund if applicable) 2.Type of Report 3.ID Number
Jennifer Hardison MacNeish for ROD 2012 Third QTR 8HA5LL
Total this Total this
Start of Election Cycle: January 1, 2012 Reporting Period Election Cycle
4) Cash on Hand at Start $ 202.58 $ 16.58
RECEIPTS
5) Aggregated Contributions from Individuals (CRO-1205) $ 50.00 $ 50.00
6) Contributions from Individuals (CRO-1210) $ 475.00 $ 1150.00
7) Contributions from Political Party Committees (CRO-1220) $ $
8) Contributions from Other Political Committees (CR0-1230) $ $
9) Loan Proceeds (CRO-1410) $ $
10) Refunds/Reimbursements To the Committee (CR0-1240) $ D EC 1 9 2012 $
11) Other Receipt Sources
11a) Interest on Bank Accounts (CRO-1250) $ $
11b) Contributions from Not-for-Profit Organizations (CRO-1250) $ $
lic) Outside Sources of Income (CRO-1250) $ $
11d) Legal Expense Fund—Other Sources (CR0.1270) $ $
12) TOTAL RECEIPTS(A d d l i n e s 5,6, 7,8,9,10, 11a,Ilb,llc and ild) $ 525.00 $ 1200.00
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO-1310) $ 338.60 $ 827.60
13b) Contributions to Candidates/Political Committees (CRO-1310) $ $
13c) Coordinated Party Expenditures (CR0-1310) $ 200.00 $ 200.00
14) Aggregated Non-Media Expenditures (CRO-1315) $ $
15) Loan Repayments (CRO-1420) $ $
16) Refunds/Reimbursements From the Committee (CRO-1320) $ $
17) In-Kind Contributions (CRO-1510) $ $
18) TOTAL EXPENDITURES(Add lines 13a,13b,13c,14,15,16 and 17) $ 538.60 $ 1027.60
19) Cash on Hand at End(Add lines 4 and 12 together,then subtract line 18) $ 188.98 $ 188.98
ADDITIONAL INFORMATION
20) Non-Monetary Gifts Given to Other Committees (CRO-1330) $
21) Outstanding Loans(incl.ones from other campaigns) (CRO-1430) $
22) Debts and Obligations owed By the Committee (CRO-1610) $
23) Debts and Obligations owed To the Committee (CR0-1620) $
24) Account Transfers Within the Committee (CRO-1720) $
25) Administrative Support (CRO-1710) $ $
26) Forgiven Loans (CRO-1440) $ $
27) 48-Hour Notice Reports Sum (CRO-2200) $ $
27) Contributions to be refunded (CRO-1215) $ $
CRO-1100 NC State Board of Elections December 2007
Amendment
Aggregated Contributions from Individuals Page 1 of 1 ® Yes ❑ No
Optional form used to report NC Contributions From Individuals of$50 or less
1. Committee Full Name(and Fund if applicable) 2.ID Number
Jennifer Hardison MacNeish for ROD
8HA5LL
3.Contributor Information
a.Amend b.Account c.Form of Payment d.In-Kind e.Date f.Amount
Code Description (mm/dd/yyyy)
Add
BW Check 08/08/12 $ 25.00
Remove
0 Add
Remove
BW Check 7/12/12 $ 25.00
EJ Add
El Remove $
O Add
0 Remove $
0 Add $
0 Remove
0 Add
CI Remove $
0 Add L.
tL 1 LUi,>_ $
0 Remove
0 Add
El Remove $
0 Add
0 Remove $
El Add $
0 Remove
Add
0 Remove $
0 Add $
0 Remove
0 Add $
0 Remove
0 Add $
0 Remove
0 Add $
0 Remove
O Add $
0 Remove _
El Add $
0 Remove
0 Add $
0 Remove
0 Add $
0 Remove
0 Add $
0 Remove
0 Add $
El Remove
O Add $
0 Remove
4. Total only this Page $ 50.00
5. Total of ALL CRO-1205 Pages $ 50.00
(This line must be on line S of Detailed Summary Page CRO-1100)
CRO-1205 NC State Board of Elections April 2007
Amendment
Contributions from Individuals Pg 1 of 2 ® 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
Jennifer Hardison MacNeish for ROD AG L L
3.Contributor Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Job Title/Profession d.Comments
(include city,state,&zip) Retired j„g/1q t44 e, .
Margaret Herring ,J
5639 Old Chapel Hill Rd. c.Employer's Name/Specific Field
Apt 812
Durham,NC 27707
DEC 1. 9 2012 tr 'eric. . vcos 34y
e.Election Sum to Date
V�r►l
$ 125.00
f.Prior g.Account Code h.Form of Payment i.In-Kind Description j.Date(mm/dd/yyyy) k.Amount
❑ BW Check 8/20/2012 $ 100.00
❑ $
❑ $
3.Contributor Information El Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Job Title/Profession d.Comments
(include city,state,&zip)
Polly Shaver Reader
313 Atlanta Ave. c.Employer's Name/Specific Field
Carolina Beach,NC 28428-5106 MI,INC.
MaGIZµr<t A li' Sel e.Election Sum to Date
w alua4or�QsAtys s $ 100.00
f.Prior g.Account Code h.Form of Payment i.In-Kind Description j.Date(mm/dd/yyyy) k.Amount
❑
BW Check 9/12/12 $ 100.00
❑
❑ $
3.Contributor Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Job Title/Profession d.Comments
(include city,state,&zip)
Donna Horne Asst.Register of Deeds
112 NE 35"'St. c.Employer's Name/Specific Field
Oak Island,NC 28468 NHCO Govt.
NHCO ROD e.Election Sum to Date
$ 75.00
f.Prior g.Account Code h.Form of Payment i.In-Kind Description j.Date(mm/dd/yyyy) k.Amount
❑ BW Check 9/28/2012 $ 75.00
❑ $
❑ $
4. Total only this Page $ 275.00
5. Total of ALL CRO-1210 Pages
475.00
(This line must be on line 6 of Detailed Summary Page CR0-1100)
CRO-1210 NC State Board of Elections April 2007
Amendment
Disbursements Pg 1 of 1 ® 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) 2.ID Number
Jennifer Hardison MacNeish for ROD 8HA5LL
3.T 'e of Disbursement Please use seIarate CRO-1310 orms or each le o Disbursement.
® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures
4.Payee Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Coordinated Committee Name d.Comments
(include city,state,&zip)
c.Level Registered(Specify)
❑ Federal ❑ County:
® State ❑ Municipality: e.Election Sum to Date
liEC 19 torL $
f.Account Code g.Form of Payment h.Purpose Code i.Date(mm/dd/yyyy) j.Amount k.Required Remarks
$
4. Payee Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Coordinated Committee Name d.Comments
(include city,state,&zip)
E White Enterprises
4804 Jessica Lane c.Level Registered(Specify)
Castle Hayne,NC 28429 ❑ Federal ❑ County:
❑ State ❑ Municipality: e.Election Sum to Date
$ 211.27
f.Account Code g.Form of Payment h.Purpose Code i.Date(mm/dd/yyyy) j.Amount k.Required Remarks
BW Check B 9/19/2012 $211.27 Stickers/Tshirt
4.Payee Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Coordinated Committee Name d.Comments
(include city,state,&zip)
Allways Graphics
120 Racine Dr. c.Level Registered(Specify)
Unit 3 ❑ Federal ❑ County:
Wilmington,NC 28403 ❑ State ❑ Municipality: e.Election Sum to Date
$ 127.33
f.Account Code g.Form of Payment h.Purpose Code i.Date(mm/dd/yyyy) j.Amount k.Required Remarks
BW Check B 09/28/2012 $127.33 Banners/Signs
5.Total only this Page $ 338.60
6.Total of ALL CRO-1310 Pages
(This line goes in line 13a of Detailed Summary Page CRO-1100 if Operating Expenses)
(This line goes in line 13b of Detailed Summary Page CRO-1100 if Contrib to Candidates/Political Comm) $ 338.60
(This line goes in line 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
0*-Other
*Codes require detailed explanation in required remarks field(k)
CRO-1310 NC State Board of Elections December 2009
Amendment
Disbursements Pg 1 of 1 ® 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) 2. ID Number
Jennifer Hardison MacNeish 8HA5LL
3.Type of Disbursement (Please use separate CRO-1310 forms for each type of Disbursement4
❑ Operating Expenses ❑ Contributions to Candidates/Political Committees ® Coordinated Party Expenditures
4.Payee Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Coordinated Committee Name d.Comments
(include city,state,&zip)
New Hanover County Dem Party Ai r 64'" Pro• Shared Campaig
1109 Princess St. c.Level Registered(Specify) Office space
Wilmington,NC 28401 'y E� ❑ Federal ❑ County:
`+/G ® State ❑ Municipality: e.Election Sum to Date
cs 1. 9 2012 $ 200.00
f.Account Code g.Form of Payment h.Purpose Code i.Date(mm/dd/yyyy) j.Amount k.Required Remarks
BW Check G 9/01/12 $200.00 Shared office
space
$
4.Payee Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Coordinated Committee Name d.Comments
(include city,state,&zip)
c.Level Registered(Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality: e.Election Sum to Date
f.Account Code g.Form of Payment h.Purpose Code i.Date(mm/dd/yyyy) j.Amount k.Required Remarks
4.Payee Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Coordinated Committee Name d.Comments
(include city,state,&zip)
c.Level Registered(Specify)
❑ Federal ❑ County:
❑ State ❑ Municipality: e.Election Sum to Date
$
f.Account Code g.Form of Payment h.Purpose Code i.Date(mm/dd/yyyy) j.Amount k.Required Remarks
5.Total only this Page $ 200.00
6.Total of ALL CRO-1310 Pages
(This line goes in line 13a of Detailed Summary Page CRO-1100 if Operating Expenses)
(This line goes in line 13b of Detailed Summary Page CRO-1100 if Contrib to Candidates/Political Comm) $ 200.00
(This line goes in line 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
0*-Other
*Codes require detailed explanation in required remarks field(k)
CRO-1310 NC State Board of Elections December 2009