2011 Organizational Report Amendment Amendment
Disclosure Report Cover ca 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
COMMITTEE TO ELECT STEVE SHUTTLESWORTH
b.Mailing Address(include City,State and Zip Code) d.Date Filed
808 CAROLINA BEACH AVE N# 1 • .��i.--- 01/24/2013
CAROLINA BEACH,NC 28428
JAN 24 2013 e.Phone Number
tkip ` 1 of FlectiOns
2.Report Year 3.Period Start Date(mm/dd/yy) 4.Period End Date(mmiddfyy) 5.Treasurer,Full Name
2011 07/14/2011 07/22/2011 STEVE SHUTTLESWORTH
6.Type of Committee(Check One) 9.Type of Report (check only one type ofreport 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
Type of Fund (if applicable, 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
:Number of Fu( s Rert ❑ Special ❑ Final
_- 0 �..mm ..... ❑ Special
3.Account Information 3.Account Information
a.Financial Institution Full Name a.Financial Institution Full Name
BANK OF AMERICA
b.Purpose c.Account Code b.Purpose c.Account Code
_.._. _........__ ., _...._._....�
CAMPAIGN FINANCE SAS
d. Period Begin Balance d.Period Begin Balance
$ 0.00 $
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 her certify that this report is complete,true and correct a' h I have been trained by the NC State Board
zit ch vtct/e kveterh 1v
� 01/24/2013
Printed Name of Signer Signature:f Appointe. reasurer Date
FOR OFFICE USE ONLY
Date Received: l? ���� s Employee:
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 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 conlinittee changes.
CRO-1000 NC State Board of Elections December 2007
Amendment
Detailed Summary pg Yes si No
Use this formto summarize all disclosure reporting forms and to total monetary infotnration
1.Committee Full Name(and Fund if applicable) 2.Type of Report 3.ID Number
COMMITTEE TO ELECT STEVE 2011 Organizational 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 $ 0.00 $ 0.00
RECEIPTS
5) Aggregated Contributions from Individuals (CRO-1205) $ 0.00 $ 0.00
6) Contributions from Individuals (CRO-1210) $ 218.00 $ 218.00
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 Pro ce eds (CRO-1410)
$ 0.00 $ 0.00
10) Refunds/Reimbursemen ts to the Q IVE (CR0-1240)
$ 0.00 $ 0.00
11) Other Receipt Sources JAN 2 4 2013
l la) Interest on Bank Accounts (CRO-1250) $ 0.00 $ 0.00
NHG Bd of Elections
I lb) Contributions from Not-For-Profit Organizations (CRO-1250) $ 0.00 $ 0.00
llc) Outside Sources of Income (CRO-1250) $ 0.00 $ 0.00
lld) Legal Expense Fund-Other Sources (CRO-1270) $ 0.00 $ 0.00
lle) Exempt Purchas e Price Sales (CRO-1265) $ 0.00 $ 0.00
12) TOTAL RECFIPTS (Add lines 5,6,7,8,9,10,1 I a,11 b,1 1 c,11 d and I le) $ 218.00 $ 218.00
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO-1310) $ 0.00 $ 0.00
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 (CRO-1420) $ 0.00 $ 0.00
16) Refunds/Reimbursements from the Committee (CRO-1320) $ 0.00 $ 0.00
17) In-Kind Contributions (CRO-1510) $ 118.00 $ 118.00
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ 118.00 $ 118.00
19) Cash on Hand at End(Add lines 4 and 12 together,then subtract line 18) $ 100.00 $ 100.00
ADDITIONAL INFORMATION
20) Non-Monetary Gifts Given to Other Committees (CRO-1330) $ 0.00
H) Outstanding Loans (incl.ones from other campaigns) (CRO-1430) $ 0.00
Z2) Debts and Obligations owed by the Committee (CRO-1610) $ 0.00
23) Debts and Obligations owed to the Committee (CRO-1620) $ 0.00
24) 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 13 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
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) OWNER
STEVE SHUTTLES WORTH
808 CAROLINA BEACH AVENUE N#1 c.Employer's Name/Specific Field
CAROLINA BEACH,NC 28428 SHUTTLESWORTH INC.
e.Election Sum to Date
$ 218.00
f.Prior g.Account Code h.Form of Payment i.In-Kind Description j.Date(mm/dd/yyyy) k.Amount
❑ SAS In-Kind CANDIDATE FILING FEE 07/14/2011
$ 118.00
❑ SAS Check 07/22/2011 $ 100.00
❑ $
4. Total only this Page $ 218.00
5. Total of ALL CRO-1210 Pages $ 218.00
(This line must be on line 6 of Detailed Summary Page CRO-1100)
CR0-1210 NC State Board of Elections April 2007
RECEIVED
JAN 2 4 2013
NHC Bd of Elections
Amendment
In-Kind Contributions Pg of 1 IA Yes 51 No
Use this form to report non-monetary contributions,donations,goods or services provided to the committee or fund.
Use CRO-1215 if In-Kind Contributions were or will be refunded within 7 days.
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.Type of Contributor c.Comments
(include city,state,&zip) ® Individual
STEVE SHUTTLESWORTH ❑ Candidate
808 CAROLINA BEACH AVENUE N#1 ❑ Party
CAROLINA BEACH,NC 28428 ❑ PAC
❑ Referendum d. Election Sum to Date
❑ Other Receipt Source
$ 218.00
e.Description f.Date (mm/dd/yyyy) g.Fair Market Amount
CANDIDATE FILING FEE 07/14/2011 $ 118.00
$
4. Total only this Page $ 118.00
5. Total of ALL CRO-1510 Pages $ 118.00
(This line must be on line 17 of Detailed Summary Page CRO-1100)
CRO-1510 NC State Board of Elections December 2007
RECEIVED
JAN 242013
NHC Bd of Elections