MacNeish 4th Quarter Report 2012 Amendment
Disclosure Report Cover I ❑ Y- es Er 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. 01/09/2012
Wilmington,NC 28411 e.Phone Number
910-538-2083
Period End Date
2.Report Year 3.Period Start Date(mm/dd/yy) 4. 5.Treasurer Full Name
(mm/dd/yy)
2012 10/21/2012 12/31/2012 Lisa R. Sherrill
I J
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 day Quarterly ❑ Pre-referendum
❑ Expenditure
❑ Legal Expense Fund
7.Type of Fund (if applicable,check one) ❑ Pre-primary ❑ First ❑ Final
❑ "Booster Fund" ❑ Pre-election ❑ Second ❑ Supplemental Final
❑ Building Fund ❑ Pre-runoff ❑ Third ❑ Annual
Semi-annual ® Fourth ❑ Special
❑ 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.Purpo$, Cji '"' c.Account Code
Campaign BW JRN Q.9 7.0\2,
d.Period Begin Balance OfjBCtpns d.Period Begin Balance
$ _ NAG 8� $
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 er non-disclosed funds.I further certify that this report R.is complet ,"true and co t and that I have been trained by the N State Bid f e)ctions. .n r
Printed Name of Signer Signature of Appointed Treasurer Date
FOR OFFICE USE ONLY
:,-. )----..
Date Received: Employee: Delivery Method
❑ N• ormal Mail
Date Postmarked: Employee: ❑ R• egistered Mail
Hand Delivered
Date Scanned: Employee: ❑ Electronically Filed
❑ Signer has not received
mandatory training
Date Data Entered: Employee:
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 2008
Amendment
Detailed Summary ❑ l'es ® 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 Fourth QTR 8HA5LL
Total this Total this
Start of Election Cycle: January 1, 2012 Reporting Period Election Cycle
11.63
4) Cash on Hand at Start $ 188.98 $
RECEIPTS _i
5) Aggregated Contributions from Individuals (CRO-1205) $ 0 $ 0
6) Contributions from Individuals (CRO-1210) $ 150.00 $ 1350.00
7) Contributions from Political Party Committees (CRO-1220) $ $
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 _ "
11a) Interest on Bank Accounts (CRO-1250) $ 9 .
11b) Contributions from Not-for-Profit Organizations (CRO-1250) $ ,AN 0.9 11-01.3 $
11c) Outside Sources of Income (CRO-1250) $ Of FOec inns
11d) Legal Expense Fund—Other Sources (CRO-1270) $ Bd
12) TOTAL RECEIPTS(Add lines 5,6, 7,8,9,10, 1/a llb,lle and 11d) $ 150.00 $ 1350.00
0
,::
13) Disbursements
13a) Operating Expenditures (CRO-1310) $ 327.35 $ 1354.95
13b) Contributions to Candidates/Political Committees (CRO-1310) $ $
13c) Coordinated Party Expenditures (CRO-1310) $ $
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,136,13c,14, 15,16 and 17) $ 327.35 $ 1354.95
19) Cash on Hand at End(Add lines 4 and 12 together,then subtract line 18) $ 11.63 $ 11.63
l l
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 (CRO-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
Contributions from Individuals Pg 1 of I ❑ 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 8HA5LL
3.Contributor Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Job Title/Profession d.Comments
(include city,state,&zip) Captain/Sheriffs Office
Lachlan J. MacNeish Jr.
616 Southerland Farm Rd. c.Employer's Name/Specific Field
Wilmington,NC 28411 NHCO Sheriffs Office
Law Enforcement e.Election Sum to Date
$ 500.00
f.Prior g.Account Code h.Form of Payment i.In-Kind Description j.Date(mm/dd/yyyy) k.Amount
❑ BW CHECK 10/25/2012 $ 150.00
❑ $
3.Contributor Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Job Title/Profession d.Comments
(include city,state,&zip)
le) 9 c.Employer's Name/Specific Field
S` !a�,. e.Election Sum to Date
OAG C3°
f.Prior _g.Account Code h.Form of Payment i.In-Kind Description j.Date(mm/dd/yyyy) _ k.Amount
❑ $
❑ $
❑ $
3.Contributor Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Job Title/Profession d.Comments
(include city,state,&zip)
c.Employer's Name/Specific Field
e.Election Sum to Date
$
f.Prior g.Account Code h.Form of Payment i.In-Kind Description j.Date(mm/dd/yyyy) k.Amount
❑ $
❑ $
❑ $
4.Total only this Page $ 150.00
5.Total of ALL CRO-1210 Pages
$ 150.00
(This line must be on line 6 of Detailed Summary Page CRO-1100)
CRO-1210 NC State Board of Elections April 2007
Amendment
Disbursements Pg 1 of 1 ❑ Yes ►C1 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 a s s licable 2.ID Number
Jennifer Hardison MacNeish for ROD 8HA5LL
3.Type of Disbursement (Please use separate CRO-1310 forms for each type of 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)
FastSigns Signs
894-4 South Kerr Ave. c.Level Registered(Specify)
Wilmington,NC 28403 ❑ Federal ® County:
❑ State ❑ Municipality: e.Election Sum to Date
$ 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 10/25/2012 $327.35 Campaign signs
Car Magnets
4.Payee Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Coordinated Committee Name d.Comym
(include city,state,&zip) HLS.JI Y
c.Level Registered(Specify)
JAN O 9 2013
❑ Federal ❑ County: �{ [y#Election.,
❑ State ❑ Municipality: tc! � Taum 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 ex•enditure code in(h.)above
A*-Media B*-Printing C*-Fundraising D- co 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