Shuttlesworth Pre-Election Amendment (2011) Amendment
Disclosure Report Cover i \'es ® 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
JAN 2 4 2013
e.Phone Number
NHC Bd of Elections
2.Report Year 3.Period Start Date(mrn/ddlyy) 4.Period EndDate=(mm/dd/yy) 5.TreasurerFuJli
2011 09/28/2011 10/24/2011 STEVE SHUTTLESWORTH
b Type of Committee(Check One) 9.Type of Report (check only one type of report from one category)
® Candidate Campaign ❑ Part} Municipal State/County Referendum
❑ Joint Fundraiser ❑ PAC ❑ Organizational ❑ Organizational ❑ Organizational
❑ Referendum ❑ Legal Expense Fund ❑ Thirty-five day Quarterly ❑ Pre-referendum
7.Type of .e, (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
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
$ 427.15 $
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 coo• .. at I have been trained by the NC State Board
4-01Q--`"C 4k& *\Q ir`f .1 / 01/24/2013
Printed Name of Signer Signature of Appointed Treasurer Date
FOR OFFICE USE ONLY
Delivery Method
Date Received: )� t//> ; Employee: ❑ 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 committee changes.
CRO-1000 NC State Board of Elections December 2007
Amendment
Detailed Summary m Yes I No
Use this formto 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
COMMITTEE TO ELECT STEVE 2011 Pre-Election RHA-706-C-001
. SHUTTLESWORTH
Start of Election Cycle: January 1, 2011 Total this Total this
Reporting Period Election Cycle
4) Cash on Hand at Start $ 427.15 $ 0.00
RECEIPTS
5) Aggregated Contributions from Individuals (CRO-1205) $ 0.00 $ 0.00
6) Contributions from Individuals (CRO-1210) $ 700.00 $ 1,668.00
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 RECEIVE°-1410) $ 0.00 $ 0.00
10) Refunds/Reimbursements to the Conunitte R - 20) $ 0.00 $ 0.00
,�AAN 24.._2Qf3 O14
11) Other Receipt Sources
11a) Interest on Bank Accounts NHC 8d Of hI 50) $ 0.00 $ 0.00
11 b) Contributions from Not-For-Profit Organizations (CRO-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 Purchas e Price Sales (CRO-1265) $ 0.00 $ 0.00
12) TOTAL RECEIPTS (Add lines 5,6,7,8,9,10,11a,11b,11c,1 1d and 11e) $ 700.00 $ 1,668.00
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO-1310) $ 886.00 $ 1,308.85
13b) Contributions to Candidates/Political Committees (CRO-1310) $ 0.00 $ 0.00
13c) Coordinated Party Expenditures (CRO-1310) $ 0.00 $ 0.00
l4) Aggregated Non-Media Expenditures (CRO-1315) $ 14.00 $ 14.00
l5) Loan Repayments (CRO-1420) $ 0.00 $ 0.00
l6) Refunds/Reimbursements from the Committee (CRO-1320) $ 0.00 $ 0.00
l7) In-Kind Contributions (CRO-1510) $ 0.00 $ 118.00
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ 900.00 $ 1,440.85
19) Cash on Hand at End(Add lines 4 and 12 together,then subtract line 18) $ 227.15 $ 227.15
ADDITIONAL INFORMATION
20) Non-Monetary Gifts Given to Other Committees (CRO-1330) $
L1) Outstanding Loans (incl.ones from other campaigns) (CR0-1430) $ 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
24) Account Transfers Within the Committee (CRO-1720) $ 0.00 - '-
Z5) Administrative Support (CRO-1710) $ 0.00 $ 0.00
26) Forgiven Loans (CRO-1440) $ 0.00 $ 0.00
27) 48-Hour Notice Reports Sum (CRO-2220) $ 0.00 $ 0.00
28) 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 1E 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) STUDENT
MICHELE CONNETT
1321 CABO COURT c.Employer's Name/Specific Field
CAROLINA BEACH,NC 28428 SELF EMPLOYED
c e.Election Sum to Date
RECEIVE $ 100.00
f.Prior g.Account Code h.Form o' 7.4 t)10-Kind Description j.Date(mm/dd/yyyy) k.Amount
❑ SAS Check 10/20/2011
t E action,
100.00
3.Contributor Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Job Title/Profession d.Comments
(include city,state,&zip) REAL ESTATE PROPERTY
CAROLINE MEEKS MANAGEMENT
206 FAYETVILLE AVENUE c.Employer's Name/Specific Field
CAROLINA BEACH,NC 28428 VICTORY BEACH
VACATION RENTALS e.Election Sum to Date
$ 300.00
f.Prior g.Account Code h.Form of Payment i.In-Kind Description j.Date(mm/dd/yyyy) k.Amount
•
❑ SAS Check 09/30/2011
$ 300.00
❑ $
❑ $
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
$ 918.00
f.Prior g.Account Code h.Form of Payment i.In-Kind Description j.Date(mm/dd/yyyy) k.Amount
❑ SAS Check _ 10/11/2011
$ 300.00
❑ $
❑ $
4. Total only this Page $ 700.00
5. Total of ALL CRO-1210 Pages
I $ 700.00
(This line must be on line 6 of Detailed Summary Page CRO-1100)
CRO-1210 NC State Board of Elections April2007
Amendment
Disbursements Pg 1 of 2 la 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
COMMITTEE TO ELECT STEVE SHUTTLESWORTH RHA-706-C-001
3.Type of Disbursement (Please use separate CRO-1310 forms for each type ofDisbursement.)
1.'t 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)
ISLAND GAZETTE
1003 BENNET LANE c.Level Registered(Specify)
CAROLINA BEACH,NC 2842R ECEIVEr ❑ Federal ❑ County:
❑ State ❑ Municipality: e.Election Sum to Date
JAN 2 4 2013 $ 144.00
f.Account Code g.Form of Pa 6 e P 1 Date(mm/dd/yyyy) j.Amount k.Required Remarks
SAS Check A 10/06/2011 $ 72.00 AD
SAS Check A 10/14/2011 $ 72.00 AD
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 ❑ Federal ❑ County:
❑ State ❑ Municipality: e.Election Sum to Date
$ 674.10
f.Account Code g.Form of Payment h.Purpose Code i.Date(mm/dd/yyyy) j.Amount k.Required Remarks
SAS _ Check B 10/04/2011 $ 272.85 SIGNS
SAS Check B 10/18/2011 $ 128.40 SIGNS
4.Payee Information ❑ Add ❑ Remove
a.Full Name,Mailing Address&Phone b.Coordinated Committee Name d.Comments
(include city,state,&zip)
LIVE BAIT CAROLINA BEACH
1208 SUMPTER AVENUE# 1 c.Level Registered(Specify)
CAROLINA BEACH,NC 28428 ❑ Federal ❑ County:
❑ State ❑ Municipality: e.Election Sum to Date
$ 250.00
f.Account Code g.Form of Payment h.Purpose Code i.Date(mm/dd/yyyy) j.Amount k.Required Remarks
SAS Check 0 10/11/2011 $ 250.00 MUSIC
5.Total only this Page $ 795.25
6.Total of ALL CRO-1310 Pages
(This line goes in line 13a of Detailed Summary Page CRO-1100 if Operating Expenses) $ 886.00
(This line goes in line 13b of Detailed 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
Amendment
Disbursements Pg 2 of 2 Q 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
COMMITTEE TO ELECT STEVE SHUTTLESWORTH RHA-706-C-00I
3.Type of Disbursement (Please use separate CRO-1310 forms for each type of Disbursement.)
1l 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 PRINTING JAN 4 Zn13
2145 WRIGHTSVILLE AVENUE c.Level Registered(Specify)
WILMINGTON,NC 28403 ❑ Federal ❑ County:
NHC Bd of EIeCtiOlj State ❑ Municipality: e.Election Sum to Date
$ 90.75
f.Account Code g.Form of Payment h.Purpose Code i.Date(mm/dd/yyyy) j.Amount k.Required Remarks
SAS Debit Card A 10/03/2011 $ 90.75 CARDS
5.Total only this Page 1 $ 90.75
6.Total of ALL CRO-1310 Pages
(This line goes in line 13a ofDetailed Summary Page CRO-1100 if Operating Expenses) $ 886.00
(This line goes in line 13b ofDetailed Summary Page CRO-1100 if Contrib to Candidates/Political Comm)
(This line goes in line 13c ofDetailed 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
Aggregated Non-Media Expenditures Page 1 of 1_ rp Yes re 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/yyy■) f.Amount g.Required Remarks
■
Add SAS Check K 09/30/2011 $ 14.00 SERVICE FEE
❑ Remove
4. Total only this Page $ 14.00
5. Total of ALL CRO-1315 Pages
(This line must be on line 14 ofDetailed Summary Page CRO-1100) $ 14.00
6. Purpose Codes (List detailed expenditure code in(d) above)
B* - Printing Fundraising D - To Another Candidate
E- Salaries F* - Equipment= G- Political Party H* - Holding Public Office Expenses
I - Postage J -Penalties * - Office Expenses Q* - Donations to Legal Expense Fund
0* - Other
* Codes require detailed explanation in required remarks field(g)
CRO-131 S NC State Board of Elections December 2009
BClt Er)
JAN 242013
Bd of Elections