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Amendment <br />Other Receipt Sources >v L of 3 ❑ Yes ❑ No <br />Use this form to report income not reported on another form. i.e. interest income, not for profit contributions etc. <br />1. Committee Full Name (and Fund if applicable) <br />2. ID Number <br />[.�," s`►�`L-��. �-„ � legit � t ��.� C l�� k � ^ C��.� <br />3. Type of Receipt Source (Please use se arale CRO-1250 forms for each type ofRecerpl Source <br />® interest ❑ Contributions from Not -for -Profit Organizations ❑ Outside Sources of Income <br />4. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state,& zip) <br />b. Not -for -Profit Federal ID # <br />d. Comments <br />j <br />5 La' _ mvi GG.s crp�I[ T <br />�Q R&'1 jc)xrA -N �Iw <br />L .t7'C'_J H. C= a 50 `� <br />'ion- 7&s - _3+44 <br />c. Outside Source k:xpEanxtiun <br />e. Election Sum to Date <br />$ 02903 <br />f. Account Code <br />g. Form of Payment <br />h. In -Kind Description <br />i. Date (mm/dd/yyyy) <br />j. Amount <br />-Lxr&i+ <br />�tl+er�s� c" Lne-g-ki nci <br />ct b I L-W14 <br />$ + 06 <br />4. Contributor <br />information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Not -for -Profit Federal ID # <br />d. Comments <br />L <br />(�o+nL_ 0YJ , g C 0a S O)L l <br />r o LL 799 -K s`f�F 4 <br />c. Outside Source Explanation <br />e. Election Sum to Date <br />1 <br />f. Account Code <br />g. Form of Payment <br />h. In -Kind Description <br />f. Date (mm/dd/yyyy) <br />j. Amount <br />4. Contributor <br />Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Not -for -Profit Federal ID # <br />d. Comments <br />S+&. C" QreAi+ t6`,w) <br />6"oowic�. ❑7r TkU� <br />L'rybh Cb �Cc { L C ox8o xi <br />f C,4-'196 - 344' <br />c. Outside Source Explana(ion <br />e. Election Sum to Date <br />$ � <br />L Account Code <br />g. Form of Payment <br />fi. In -Kind Description <br />E. Date (mmldd/yyyy) <br />j. Amount <br />j_Dfa4t <br />/;W,2 } <br />04-, <br />5. Total only this Page <br />$ 3't <br />6. Total of ALL CRO-1250 Pages ryry 'j <br />{rkis lingoes in line Ila of Detailed Summary Page CRO-1100 if InlemW) $ <br />(This Iinegoer in line lib of Detailed Summary Page CRO-1100 if Not for-Profrl Contribution) <br />(This line goes in line 1lc of Detailed Summary Page CROr1100 if Outside Sources of Income) <br />CRn--lass NC State Board of Elections December 2007 <br />