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Amendment <br />Disbursements Pg of ❑ Yes No <br />Use this form to report expenditures from the committee for; operating expenses, contributions to candidate/political <br />committees and coordinated party expenditures. <br />1. Committee Full Name and Fund if applicable 2. ID Number <br />rYrxr,� 0—e- is Z4 e-CA t` , c e �r� <br />3. Type of Disbursement Please use se arafe C 0-131U fonns for each type of Disbursement <br />® Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures <br />4. Payee Information Add Lj Remove <br />a. Full Name, Mailing Address & Phone <br />include city, state, & xi <br />b. Coordinated Committee Name <br />d. Comments <br />S4�+O— Lf y\00Lie p& cya-A Ur• o n <br />�� �a+ �oYd -�yrr � � <br />cc, n e a+r� , �1 C- � �3v a 7 <br />jv� - 9 S43- 3444 <br />c. Level Registered (Specify) <br />El Federal El County: <br />state ❑ Municipality. <br />e. Election Sum to Date <br />f. Account Code <br />g. Form of Payment <br />h. Purpose Code <br />i. Date (mmlddlyyyy) <br />j. Amount <br />k. Required Remarks <br />I <br />-Dr,f <br />0 <br />0'/ « J ac ,14 <br />' l . & e- <br />Ba.>•,K �e.� <br />-]ra-i t <br />C1 <br />O'A f �� ac,--zT <br />+ <br />I , I . " <br />•r <br />4. Payee Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />include city, state, & <br />b. Coordinated Committee Name <br />d. Comments <br />' `� �bY� <br />C'Vt')WY-jjJL 'ASOAll <br />c. Level Registered (Specify) <br />❑ Federal ❑ County: <br />❑ Statc ❑ Municipality: <br />e. Election Sum to Date <br />/ � 60 <br />f. Account Code <br />g. Form of Payment <br />IT. Purpose Code <br />i. Date (mm/dd/yyyy) <br />j. Amount <br />k. Required Remarks <br />r <br />t <br />1US � � 4 <br />1,-G <br />113ak Fegts <br />P s.� I ' ` <br />i <br />GG <br />'r <br />4. Payee Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />include ci , state, & ai <br />b. Coordinated Committee Name <br />d. Comments <br />Swe— s-- p1t res ► [' 1AC� 1 B�1 <br />6(,,� - I --{1� <br />0 Rat .OVA —by 'RW <br />C0nGo-;1-, 4 0- "� god <br />7o+- 3444 L <br />C. Level Registered (Specify) <br />❑ Federal ❑ County: <br />❑ State ❑ Municipality_ <br />e. Election Sum to Date <br />$ 157- 00 <br />f. Account Code <br />g. Form of Payment <br />h. Purpose Code <br />i. Date (mmlddlyyyy) <br />j. Amount <br />k. Required Remarks <br />I <br />-D t <br />a <br />dT-1 13 ;;Lc, z4 <br />$ I . <br />i 0-IV— <br />1 <br />--b2ttt 06r ( dto.24 $ <br />Page $00 <br />5. Total onIX this <br />6. Total of ALL CRO-1310 Pages <br />(Thu fine goes in fine 13a ofDedailed Summary Page CRO-1100 if Operapng Fagrenses) $ f S e)v <br />(This line goes in line 13b of Dedailed Summary Page CRO-1100 if COW)lb to CandidaxevFalitrcal Comm} + <br />(This lingoes in line 13c of Dedailed Summary Page CRO-1100 if Caor&nsled Party Fxpendldares) ' <br />7. Purpose Codes (List detailed expenditure code in Qh.) above) <br />A* - Media B* - Printing C* - Fundraising D - To Another Candidate <br />E - Salaries F* - Equipment G - Pc4itical Party W - Holding Public Office Expenses <br />I - Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund <br />O* - Other <br />* Codes require detailed explanation in r uired remarks field k <br />CRO-1310 NC State Board of Elections December 2009 <br />