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Amendment <br />Other Receipt Sources Pg of A ❑ 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 a lieable) <br />2. ID Number <br />3. Type of Receipt Source Please use separate CRO-I250 Lorm for each type a Recel t Sources <br />® Interest ❑ Contributions from Not -far -Profit Organizations ❑ Qutside Sources of income <br />4. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, flailing Address & Phone <br />(include city, stat(, & zip) <br />b. Not -fur -Profit Federal Ili k <br />d. Comments <br />60 R�� fitz�d --Dy uo <br />C_ JL lac) <br />c. Outside Source Explanation <br />e. Election Sum to Date <br />f. Account Code <br />g. Form of Payment <br />h. In -Kind Description <br />i. Date [mmlddlyyyyj <br />j. Amount <br />-L-k I- � _�� <br />14e-Test- cn <br />9 lP a <br />$ - <br />4. Contributor <br />Information ❑ Add ❑ Remove <br />a. Full Name, NISiting Address & Phone <br />(include city, state, & zip) <br />h. Not -fur -Profit Federal ID # <br />d. Comments <br />ADD Kai..orJ 7Dr 40 <br />0_0 t1G0lr24 y 4 C as O 7 <br />2O L- 793 - S444 <br />c. Outside Source Explanation <br />e. Election Sum to Date <br />$ S 7 <br />f. Account Code <br />g- Form of payment <br />h�In-Kind Description <br />i. Date (mmlddfyyyy) <br />j. Amount <br />f <br />�YC�-� 1 <br />�� <br />rf►^� �57 t VN G'ew "(V, <br />(>r, Ghe'jxti ,C, <br />V'Y'l 2_",zq <br />$ r U �e• <br />/f)/ la.'.'4 <br />$ o <br />4. Contributor <br />Information ❑ Add ❑ Remove <br />a. lull Name, Mailing Address & Phone <br />(include city, stale, & zip) <br />b. Not -far -Profit Federal ID # <br />d. Comments <br />Sod+G' _ 1" 00 4 &_LS QveA�1+ <br />Io <br />cod r%C{]r-4, 4 C .A so;tq <br />104- '1 eF - 3 444 <br />G Outside Source F',xpis nation <br />e. Election Sum to Date <br />$ � � 5� <br />f. Account Code <br />g. Form of Payment <br />h. In -Kind Description <br />L hate (mmlddlyyyy) <br />j. Amount <br />x4 <br />5. Total only this page $ -13 <br />5. Total of ALL CRO-1250 Pages <br />(Thu line goes in line Ila of Detailed Summary Page CRO-1100 tf lnlerest) $ <br />(This line goes in line I h of Detailed Summary Page CR0-I100 if Not for -Profit Contribution) <br />("Phis Hite go es in line Ile of Detailed Summary Page CRO-I100 if Outride Sources of lnrame) <br />CRO-1250 NC State Board of Flections December 2007 <br />