BOARD OF ELECTIONS
BTII{COMBE COUNTY
Jones P.
P.O. Box 7468
Asheville, NC 28802
Telephone 828 -250 -4200
Fax828-250-6262
By'r{ Charrman
Lucy Smith, SecretarY
Bob Van Wagner, Member
Trena Parker, Director
RECETPT O.F CASXPAIC!{ REPORT
DArE
7/Bl
H
FUr.r. NAME OF CANDIDATE OR COMMITTEE)
(OFFICE OF CANDIDATE OR PAC)
c4ID]DAQI
Title (CIRCLE oNE):
(PERSON FILING REPORT)
(PHONE NUM ER)
4Y'"9
oF COMMITTEE)
REPORT
-r/\,/
2011 ORGANIZATIONAL
lSTQUARTER
2011 MID YEAR SEMr-ANNUAL
48 HOUR
35 DAY
2ilD QUARTER
PRE-PRIMARY
2OI2
PRE.ELE TION
3RD
2011 YTAR END SEMI-ANNUAL
48 HOUR
20 L2 M.ID YEAR SEMI-ANNUAL
4TH QUARTER
]MTD
YEAIT SEMI.ANNUAL
QUARTER
2012 YEAR ENID SEMI-ANNUAL
AIIIENDMENT
RECEIVED BY:
FINAL
, BUNCOMBE COUNTY I3OARD OF ELECTIONS
BCBOERR VER 1.O
Disclosure Report
Am en dm ent
Cover
Et
Yes H
No
submitted along with other detailed forms
Use this form for general report and committee infornution, rrust be signed and
ff nllon.
his fomrto
tomlto uDdate information
Do not use thls
| - Cnmmitfee [nformation
c.
ID Number
BLTNCOMBE FORWARD
ddrpss linelrrdp Citv- State end Zin Code)
l\fo i I
ajlt32al1
124 RIDGEVIEWROAD
ALEXANDE&NC 28701
Remrt Year
13.
Period Start Date (mm/dd/vy)
4. Period End Date (m mldd/YY)
0U0U2011
a6B0l20t1
2011
5.
e. Phone Numtrer
9J"*
Tvre of Committee (CheckOne)
Campaign E
fl
E PAC
tr Indepen&nt Expenditure [
tr
Candidate
PuttY
Referendrm
:oAt
Frardraiser
EI Legal Expense Fund
.
Trrre of
tr
tr
n
Fund
ffapplicable. check one)
of
R"rnrt
{chee
DOROTHEA ALDEMER
k only one
Referendum
tr
tr
tr
tr
tr
I
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
Number of Fun&aisers this l
Organizational
Thirty-f,we day
Pre-primary
Pre-election
Pre-rtmoff
tr
tr
tr
E]
I
E
Year End
Special
I
Financial Institution Full Name
QuarterlY
First
Second
Third
Forth
Organizational
Pre-referendrrn
Final
Sr-pplemental Final
Annual
Special
10. Spe_cial Report Name.
Mid Year
tr Year End
fl rinat
E speciat
Final
l. Account Information
Organizational
Semi-annual
Mid Year
0
a.
of reportfrom one category)
State/Cou nty
Semi-annual
Other:
ryupe
Municipal
Booster Fund
Building Fmd
5. Treasurer Firll Name
l.
Account Information
Financial Institution Full Name
BB&T
CHECKING ACCOUNT TO
COLLECT CONTRIBUT1ONS
AND MAKE DISTRIBUTIONS
c.
tr. Purpose
c. Account Code
b. Purpose
Account Code
BFl
d. Period Begin Balance
d. Period Begin Balance
$
$
CM.TIF'ICATION
I certiff that the Committee or Fund is in compliance with all applicable provisions of Article Z2A'228 &22D-22M of Chapter
funds. I further certiff
163 of the NC General Statutes and that no funds are commingled with prohibited or other non-disdosed
that this report is complete, true and correct and that I have been trained by the NC State Bomd of Elections.
t),i, A i**aif #g
Printed Narne of Sigrrer
01/t3l20tt
,*.'
Date
FOR OFFTCE USE ONLY
Date Received:
Employee:
qplrvsly-Ug$ed
fI NomalMail
Date Postmiarked:
Employee:
El Registered Mail
EI Hand Delivered
Date Scanned:
Employee:
Date Data Entered:
Employee:
E
fl
Electronicalty Filed
Signerhas not received
nrandatory training
be used to amend committee inforrration such as the committee address, treasurer'
custodian of books information, or account infonrntion.
treasurer,
assistant
you must amend the Statenpnt of Organization (CRO-2100A-E) to make comrnittee changes.
Please Note: This form cannot
cRo-l000
NC State Bo
ctlons
'
Amendment
lE
Detailed SummatY
Ise this formto sunnnarize all disclosure
r 1a^-nii4oa Fhll Nqme {en.l Fllnd iIanillcaueI
Z.
Startof ElectionCycle: January
on
l,
llandat Start
Total this
Election Cycle
Total this
-y
fromlndividrals
6) Contrihrtions from Indiri&rals
7) Contributions from Political Party Committees
8) Contributions from Other Potitical Cormnittees
9) I-mnProcee&
t0) Refun&/Reimhrrsements to the Committes
$
0.00
(cRo-1205)
$
0.00
GRo'1210)
$
998.25
(cRo-1220)
s
0.00
(CRO-1230)
$
0.00
GRo-r410)
$
o.0o
(cRo-1240)
$
0.00
L1) Other ReceiP Sources
Accounts
QRo-r250)
b) Contrihltions from Not-For-Profi t Organization
s
(CRo-
12 5 0
)
0.00
0.00
$
$
$
$
$
$
s
s
0.00
998.2s
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
998.25
$
998.25
0.00
$
0.00
0.00
$
0.00
0.00
$
o.oo
(cRo-r420)
$
$
$
$
$
GRo-1320)
$
0.00
(CRo-1270)
GRo-1265)
lle) BemntPurchasePriceSales
Zl fOtAl, nnCmfS teoA m"' s, O'7'8'9'10'
$
$
$
$
$
s
0.00
$
$
$
$
(cRo-1250)
oflnconre
r{r r eqrl Fkrcnse Firnd - Other Sources
11c) Outsi& Sources
11
ID Number
Remrtinq Period
5) AggregatedContributions
11
3.
Tvre ofReport
RECEIPTS
1La) InterestonBank
No
2011 Mid Year Semi-Annual
BUNCOMBEFORWARD
4) Cash
Yes E
infornntion
rne tbrns and to tot
0.00
0.00
0.00
0.00
EXPENDITT'RES
3) Dishrrserrents
13a) Operating
kpenditures
GRo'1310)
13b) Contrihrtions to Candidates/Political Cornmittees GRo-
I
I 0)
3
CoordinatedPartykpenditures
GRo-1310)
[4)
AggregatedNon-NtrediaExpenditures
QRo-1315)
L5)
I-on
13c)
Repayments
L6)Refun&/ReimhrrsenrentsfromtheCommittee
17)
rn-KindContrihrtions
g) TOTAL DGE}{DITI]RES
GRo-1s10)
T
s)C*h""tl""d"tE'd(Addlines4and12together,thensubtractlinel8)
S-DrrroN n r, n i nonN{ A.TIoN
|0) Non-Monetary Gifts Giren to Other
11) Outstanding
Inns
Committees
(incl. ones from other campaigns) GRo-1430)
Commit0ee
!3) Debts andOtiligations ornedtothe Committee
14) Account Transfers Within the Committes
15) A&ninistratirrc Support
16) Forgirrcnloans
rzt dR-frorrr Nntice Remrts Sum
E) C""ttthtd"* t"n n nt"O",l
12) Debts andObtigations orredby the
CRO.
(CRo-1330)
ate
GRo-1610)
GRo-1620)
(CRo-1720)
(CRo-1710)
(CRo-1440)
(cRo'2220)
@
10ns
$
$
$
$
$
$
$
$
$
$
$
$
323.25
$
$
$
$
s
675.00
$
0.00
0.00
323.25
0.00
0.00
0.00
323.25
323.25
675.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$
$
$
$
0.00
0.00
0.00
0.00
Amendment
E v". E No
-?-under $50 if formCRO 1205 is not used
pg __1 _
Contributions from Individuals
contnbutions over $50 or contributions
ts form to report individual co
Use this
or
ffid!4Ue)
2. ID Number
BUNCOMBEFORWARD
E Add E
3. Contrihrtor Information
r. Full Name, Mailing Address & Phone
(include city, state, & ziP)
Comments
d.
RETIRED
DOROTHEA ALDERFER
l24RIDGEVIEW
ALEXANDER,NC
Rennve
b. .Iob Tltle/Profession
Enploye r's Name/SPecific trIeld
28701
e. Election Sum to Date
$
Prior ls. Account Code h. Form ofPaymenl
tr
tr
BF1
k. Amount
Date (mm/dd/yyyY)
i, In-Kind DescriPtion
Check
125.00
$
02/15/2011
125.00
$
tr
$
[
C-ontrihrtor Information
a. Flrll Name' Maiting Address & Phone
(include city, state' & ziP)
3.
,A.ao
D.
E
Rerrcve
.Iob Tltle/Profe
ssi on
il. Comments
DRESIDENT
MARK CATES
Enployer's Name/SPecific Field
6 CURTIS DRIVE
GLASSCO,INC
ASHEVILLE, NC 28804
e. Election
Sun to Date
$
i.
Prior
q.
Account Code h. Form ofPayment
BFI
tr
k, Arnount
Date (mm/dd/yyYY)
In-Kind Description
Check
450.00
$
05/01/2011
n
$
tr
$
ffi
E Add E
Renpve
Title/Profession
r. trLrll Name,
b. Job
ROBERT MALT
16 GLEN COVE ROAD
r hployer's
Mailing Address & Phone
(include city, state, & ziP)
11.
Comments
e,
flection Sum to Date
Name/SPecific Fleld
ARDEN,NC 28704
s
L
Prior
tr
tr
q,
Account Code h. Form ofPayment
In Kind
BF1
PAYMENTFORPHONE
s
06/3012011
CALLS
323.25
$
$
E]
t. Total only this Page
5. Total of ALL CRO-1210 Pages
cRo-L2
323.25
k. Amount
i. Date (mm/dd/YYYY)
i. In-Kind Description
(This line mustbe on line 6 of Detaikd Summary Page
450.00
CRO-In0)
ate Board
tons
$
898.25
$
998.25
Amendment
_z_ or -?- Ev"' ENo
1205 is not used
under $50 if form CRO
ps
Contributions from Individuals
Use this form to report individual contributions over $50 or contributions
2.
f. Corunittee FbII Name (andFtrndif apdicaHe)
ID Nurnber
BUNCOMBEFORWARD
3.
E aoo Ef Rernove
Conhihrtor Inforrnation
d. Comments
b, Job Tltle/Profession
r. Fhll Name, Mailing Address & Phone
(include city, state, & ziP)
ROBERT MALT
16 GLEN COYE DR
hrployer's Name/Specifi
PRESIDENT,MN-T
ARDEN,NC 28704
c Fi
eld
7
COMPAIYY
e,
ftection Sum to Date
$
L
Prior
tr
g. Account Code
r. Form ofPayment
BFl
,
k. Amount
Date (mm/dd/yyyy)
In-Kind DescriPtion
Check
$
021r512011
tr
tr
l. Total only this Page
i. Total of ALL CRO-1210
100.00
100.00
$
$
Pages
$
100.00
$
998.25
(This line must be on line 6 of Detailcd Summary Page CRO-I100)
NC Sate
ton s
Ap
In-Kind
Contributions
Ps
-1--
or
Amendment
--1
-
H
v"'
E
t'ro
Use this form to report non-monetary contributions, donations, goods or services provided to the committee or fund.
Use CRO-1215
Kind Contributions were or will be refunded within
t. Conurittee Firll Narne (andFirndif adicaHe)
Z.
ID Number
c.
Comments
BUNCOMBEFORWARD
fl Add E
l. Conhi hrior Inforrmtion
r.
Rernove
Tlpe of Contributor
Ftrll Name, Mailing Address & Phone
b.
(include city, state, & ziP)
EI
Individual
I
I
Candidate
I
I
Referendum
ROBERT MALT
16
GLENCOVE ROAD
I
ARDEN,NC 28704
farty
rac
il. Election Sum to Date
Oth"r Receipt Sowce
t
l, Description
PAYMENT FORPHONE CALIS
$
323.25
Fair Market Amount
Date (rnm/ddlyyyy)
$
06/30120rt
323.2s
$
$
l. Total only this Page
i. Total of ALL CRO-1510
$
Pages
; S
(This line must be on tine 17 of Detaileil Summary Page CRO-I100)
C
I
$ate
lons
323.25
323.2s