2012 Mid-Year Report Amendment Amendment
Disclosure Report Cover D4 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 Ic.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 RECEIVED
e.Phone Number
JAN 24 2013
2 Report Year 3 Pe riodStart.Date(mm/ddlyv) _ _4.P `1 4,3,} • ` t.°:.,14 1. ;,14�1 Trenrer l Name .... x
.1
2012 01/01/2012 06/30/2012 STEVE SHUTTLESWORTH
6.Type of Committee(Check One) 9.Type of Report (check only one type ofreport front one oak o?y) `,
® Candidate Campaign ❑ Party Municipal State/County Referendum
V m
❑ Joint Fundraiser ❑ PAC ❑ Organizational ❑ Organizational ❑ Organizational
❑ Referendum ❑ Legal Expense Fund ❑ Thirty-five day Quarterly ❑ Pre-referendum
# leol i'und (f applicable,the nne) : ❑ 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 1 pecial:Report Name
❑ Other: ❑ Final ❑ Year End
8.Number of Fundraisers this Report ❑ Special ❑ Final
0 0 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
$ 176.74 $
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 report is complete,true and corre c mums .t I have been trained by the NC State Board
S- C,.2 "-k\e igd _0 AlliliP 01/24/2013
Printed Name of Signer Signature of Appointed Treasurer Date
FOR OFFICE USE ONLY
i5 T Delivery Method
Date Received: Yi 3 Employee:` ❑ Normal Mail
Date Postmarked: Employee: ❑ Registered Mail
Hand Delivered
Date Scanned: Employee: 0 Electronically Filed
Date Data Entered: Employee: 0 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 committee changes.
CRO-1000 NC State Board of Elections December 2007
Amendment
Detailed Summary 01 Yes I 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 3.1D Number
COMMITTEE TO ELECT STEVE 2012 Mid Year Semi-Annual RHA-706-C-001
SHIJTTI,ESWORTH
2012 Total this Total this
Start of Election Cycle: January 1, Reporting Period Election Cycle
4) Cas h on Hand at Start $ 176.74 $ 176.74
RECEIPTS
5) Aggregated Contributions from Individuals (CRO-1205) $ 0.00 $ 0.00
6) Contributions from Individuals (CRO-1210) $ 0.00 $ 0.00
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 C ftECE1VED(CRO-1240) $ 0.00 $ 0.00
11) Other Receipt Sources JAN 2 4 2013
11a) Interest on Bank Accounts (CRO-1250) $ 0.00 $ 0.00
11 b) Contributions from Not-For- ro Organizations RO-1250) $ 0.00 $ 0.00
11c) Outside Sources of Income (CRO-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 5,6,7,8,9,10,1 1 a,11 b,11 c,1 1 d and Ile) $ 0.00 $ 0.00
EXPENDITURES
13) Disbursements - 11=1.1.11.M1
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) $ 84.00 $ 84.00
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) $ 0.00 $ 0.00
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15,16 and 17) $ 84.00 $ 84.00
19) Cash on Hand at End(Add lines 4 and 12 together,then subtract line 18) $ 92.74 $ 92.74
ADDITIONAL INFORMATION
0) Non-Monetary Gifts Given to Other Committees (CRO-1330) $ 0.00
11) Outstanding Loans (incl.ones from other campaigns) (CRO-1430) $ 0.00
12) Debts and Obligations owed by the Committee (CRO-1610) $ 0.00
Z3) 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
CRD-1100 NC State Board of Elections August 2008
Amendment
Aggregated Non-Media Expenditures Page 1 of 1 ip Yes Egi No
Optional form used to report NC Non-Media Expenditures of$50 or less.
1.Committee Full Name(and Fund if applicable) 2.ID Number
COMMITTEE TO ELECT STEVE SHUTTLESWORTH _ RHA-706-C-001
3.Payee Information
a.Amend b.Account Code c.Form of Payment d.Purpose Code e.Date (mm/dd/yyyy) f.Amount g.Required Remarks
tr—A'dd SAS Electric Funds Tran O 01/30/2012 $ 14.00 BANK CHARGE
❑ Remove
❑ Add SAS Electric Funds Tran O 02/28/2012 $ 14.00 BANK CHARGE
❑ Remove
in Add _ SAS Electric Funds-M EL, 03/30/2012 $ 14.00 BANK CHARGE
❑ Remove
❑ Add SAS Electric Funds Tram Aft' 2 4 2013 04/30/2012 $ 14.00 BANK CHARGE
El Remove JH'`t
❑ Add SAS Electric Fun TT�,�'r��'(p ��QQ 05/30/2012 $ 14.00 BANK CHARGE
❑ RemoveI IV G � ( L1Q1:,
❑ Add . SAS Electric Funds Tran 0 06/30/2012 $ 14.00 BANK CHARGE
❑ Remove
4. Total only this Page $ 84.00
5. Total of ALL CRO-1315 Pages $ 84.00
(This line must he on line 14 of Detailed Summary Page CRO-I100)
6. Purpose Codes (List detailed expenditure code in(d) above)
B* - Printing C* - Fundraising D - '1 o Another Candidate
E - Salaries i * -Equipment G - Political Party H* - Holding Public Office Expenses
I -Postage ` J - Penalties IV L- Q_ffice_ penses Q* - Donations to Legal Expense Fund
O* - Other
* Codes require detailed explanation in re quire d re marks field (g)
CRO-1315 NC State Board of Elections December 2009