2011 35 Day Report Amendment Disclosure Report Cover ts Y smen® 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
COMMITTEE TO ELECT STEVE SHUTTLESWORTH RHA-706-C-001
b.Mailing Address (include City,State and Zip Code) d.Date Filed
808 CAROLINA BEACH AVE N# 1 01/24/2013
CAROLINA BEACH,NC 28428
e.Phone Number
2 Report Year 3.Period Start Date(mm/dd/yy) 4.Period End Date(mm/drvyy) 5.Treasurer Ful`
2011 07/23/2011 09/27/2011 STEVE SHUTTLESWORTH
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
❑ Joint Fundraiser ❑ PAC ❑ Organizational ❑ Organizational ❑ Organizational
❑ Referendum ❑ Legal Expense Fund ® Thirty-five day Quarterly ❑ Pre-referendum
7.Type of Fund apid check one) ❑ Pre-primary ❑ First ❑ Final
❑ "Booster Fund" ❑ Pre-election ❑ Second ❑ Supplemental Final
❑ Building Fund ❑ Pre-runoff ❑ Third ❑ Annual
❑ Presidential Election Year Candidates Fund Semi-annual ❑ Fourth ❑ Special
❑ NC Public Campaign Financing Fund ❑ Mid Year Semi-annual
❑ Year End ❑ Mid Year 10.Special Report Name
❑ Other: ❑ Final ❑ Year End
8.Number of Fundraisers this Report ❑ Special ❑ Final
0 ❑ Special
3.Account Information 3.Account Information
a. Financial Institution Full Name a.Financial Institution Full Name
BANK OF AMERICA
h. Purpose c.Account Code b.Purpose c.Account Code
CAMPAIGN FINANCE SAS 11ECqq
d.Period Begin Balance JAN 2 4 2013 d.Period Begin Balance
$ 100.00 l( F
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. I further certify that this repo is complete,true and cone 4000) I have been trained by the NC State Board
�0Vlh10 —i40# 01/24/2013
Printed Name of Signer Signa ure of Appointed Treasurer Date
FOR OFFICE USE ONLY
Date Received: 1/_,-;�` Employee: t r _--- Delivery Method
❑ Normal Mail
Date Postmarked: Employee: ❑ Registered Mail
[a--Hand Delivered
Date Scanned: Employee: ❑ Electronically Filed
Date Data Entered: Employee: ❑ Signer has not received
mandatory training
Please Note:This form cannot be used to amend cormttee 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 December 2007
Amendment
Detailed Summary IJ Yes ® No
Use this form to summarize all disclosure reporting forms and to total monetary infouiration
1.Committee Full Name(and Fund if applicable) 2.Type of Report 3.ID Number
COMMITTEE TO ELECT STEVE 2011 Thirty-five-day RHA-706-C-001
SHUTTLES WORTH
Start of Election Cycle: January 1, 2011 Total this Total this
Reporting Period Election Cycle
4) Cash on Hand at Start $ 100.00 $ 0.00
RECEIPTS
5) Aggregated Contributions from Individuals (CRO-1205) $ 0.00 $ 0.00
6) Contributions from Individuals (CRO-1210) $ 750.00 $ 968.00
7) Contributions from Political Party Committees (CRO-1220) $ 0.00 $ 0.00
8) Contributions from Other Political Committees (CRO-1230) $ 0.00 $ 0.00
9) Loan Proceeds (CRO-1410) $ 0.00 $ 0.00
10) Refunds/Reimbursements to the Committee (CRO-1240) $ 0.00 $ 0.00
l l) Other Receipt Sources FCF1\1C
11a) Interest on Bank Accounts ,, �[� (CRO-1250) $ 0.00 $ 0.00
11b) Contributions from Not-For-Profit Organza'ons (CR0-1250) $ 0.00 $ 0.00
llc) Outside Sources of Income NHC Bd of Electior(SR0 1250) $ 0.00 $ 0.00
11d) Legal Expense Fund-Other Sources (CRO-1270) $ 0.00 $ 0.00
11e) Exempt Purchase Price Sales (CRO-1265) $ 0.00 $ 0.00
12) TOTAL RECEIPTS (Add lines 5,6,7,8,9,10,11a,11b,11c,11d and l le) $ 750.00 $ 968.00
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO-1310) $ 422.85 $ 422.85
13b) Contributions to Candidates/Political Committees (CRO-1310) $ 0.00 $ 0.00
13c) Coordinated Party Expenditures (CRO-1310) $ 0.00 $ 0.00
14) Aggregated Non-Media Expenditures (CRO-1315) $ 0.00 $ 0.00
15) Loan Repayments (CR0-1420) $ 0.00 $ 0.00
16) Refunds/Reimbursements from the Committee (CRO-1320) $ 0.00 $ 0.00
17) In-Kind Contributions (CRO-1510) $ 0.00 $ 118.00
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ 422.85 $ 540.85
19) Cash on Hand at End(Add lines 4 and 12 together,then subtract line 18) $ 427.15 $ 427.15
ADDITIONAL INFORMATION
ZO) Non-Monetary Gifts Given to Other Committees (CRO-1330) $ 0.00
Zl) Outstanding Loans (incl.ones from other campaigns) (CRO-1430) $ 0.00
Z2) Debts and Obligations owed by the Committee (CRO-1610) $ 0.00
Z3) Debts and Obligations owed to the Committee (CRO-1620) $ 0.00 lio,
Z4) Account Transfers Within the Committee (CRO-1720) $ 0.00
Z5) Administrative Support (CRO-1710) $ 0.00 $ 0.00
Z6) Forgiven Loans (CRO-1440) $ 0.00 $ 0.00
Z7) 48-Hour Notice Reports Sum (CRO-2220) $ 0.00 $ 0.00
Z8) Contributions to be Refunded (CRO-1215) $ 0.00 $ 0.00
CRO-1100 NC State Board of Elections August 2008
Amendment
Contributions from Individuals Pg 1 of 1 ® Yes 1,1 No
Use this form to report individual contributions over$50 or contributions under$50 if fonn CRO 1205 is not used
1.Committee Full Name(and Fund if applicable) 2.ID Number
COMMITTEE TO ELECT STEVE SHUTTLESWORTH RHA-706-C-001
3.Contributor Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Job Title/Profession d.Comments
(include city,state,&zip) ,REAL ESTATE
DELORES KIRKBRIDE
CAROLINA BEACH,NC 28428 c.Employer's Name/Specific Field
ECEIVFO OCEAN GROVE COTTAGES
e.Election Sum to Date
JAN 2 4 2013 $ 250.00
f.Prior g.Account Code h.Form of Payment i.In-Kind Description j.Date(mm/dd/yyyy) k.Amount
❑ SAS ilftlaBd of ZIections 09/19/2011 $ 250.00
❑ $
❑ $
3.Contributor Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Job Title/Profession d.Comments
(include city,state,&zip) RETIRED
JEROME RAMSEY
4901 OAKMOOR COURT c.Employer's Name/Specific Field
RALEIGH,NC 27614 SELF-EMPLOYED
e. Election Sum to Date
$ 100.00
f.Prior g.Account Code h.Form of Payment i.In-Kind Description j.Date (mm/dd/yyyy) k.Amount
❑ SAS Check 09/15/2011 $ 100.00
❑ $
❑ $
3.Contributor Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Job Title/Profession d.Comments
(include city,state,&zip) OWNER
STEVE SHUTTLESWORTH
808 CAROLINA BEACH AVENUE N#1 c.Employer's Name/Specific Field
CAROLINA BEACH,NC 28428 SHUTTLESWORTH INC.
e.Election Sum to Date
$ 618.00
f.Prior g.Account Code h.Form of Payment i.In-Kind Description j.Date (mm/dd/yyyy) k.Amount
❑ SAS Check 09/23/2011
$ 400.00
❑ $
❑ $
4. Total only this Page ! $ 750.00
5. Total of ALL CRO-1210 Pages $ 750.00
(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 1 173 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.II)Number
COMMITTEE TO ELECT STEVE SHUTTLESWORTH RHA-'/06-C-001
3.Type of Disbursement (Please use separate CRO-1310 forms for each type of Disbursement.)
Il Operating Expenses ❑ Contributions to Candidates/Political Committees in Coordinated Party Expenditures
4.Payee Information ❑ Add ❑ Remove
a.Full Name,Mailing Address &Phone b.Coordinated Committee Name d.Comments
(include city,state,&zip)
KENNETH MOORE SIGNS
PO BOX 1295 c.Level Registered(Specify)
CAROLINA BEACH,NC 28428 RECEIVEI ❑ Federal 0 County:
❑ State ❑ Municipality: e.Election Sum to Date
JAN 2 4 2013
$ 272.85
f.Account Code g. Form of Pa
ym a yyy�) j. Required Odle{ eet O Ste(mm/dd/ � v Amount k. Rc uired Remarks
SAS Check B 09/23/2011 $ 272.85 SIGNS
4.Payee Information ❑ Add ❑ Remove
a.Full Name,Mailing Address &Phone b.Coordinated Committee Name d.Comments
(include city,state,&zip)
THE GRAPHIC IMAGE
2840 GALLEY ROAD c.Level Registered(Specify)
WILMINGTON,NC 28412 0 Federal ❑ County:
❑ State ❑ Municipality: e.Election Sum to Date
$ 150.00
f.Account Code g.Form of Payment h.Purpose Code i.Date (mm/dd/yyy∎) j.Amount k.Required Remarks
SAS Check B 09/26/2011 $ 150.00 BROCHURES
$
5.Total only this Page $ 422.85
6.Total of ALL CRO-1310 Pages
(This line goes in line 13a of Detailed Summary Page CRO-1100 if Operating Expenses) $ 422.85
(This line goes in line 13b ofDetailed Summary Page CRO-1100 if Contrib to Candidates/Political Comm)
(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