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Amendment <br />Disbursements of ❑ Yes jj No <br />Use this form to report expenditures from the committee for, operating expenses, contributions to candidate/political <br />committees and coordinated Dart►+ expenditures. <br />1. Committee Full Name and Fund if applicable) <br />2. ID Number <br />e.g. 4c Zle<A : w C � r v <br />3. of Disbursement Please use se anne C 00-1310 form for each o Dis6r�rsenre►rL <br />® operating Expenses ❑ Contributions to CandidatesNotiticai Couunift= ❑ Coordinated Party Expenditures <br />4. Payee Information Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />include city, state, & a <br />b. Coordinated Committee Name <br />d. Comments <br />94� -LmQ1t:4e- es CYO } LVri : o r' <br />0 Hai �°Y't 3�r N w <br />Con e� , [� 3v a <br />7 <br />c- [Avd Registered (S�ily) <br />❑ Federal County: <br />❑ State ❑ Municipality: <br />e. Election Sum to Date <br />$ 151 00 <br />E Account Cade <br />g. Form of Payment <br />h. Purpose Cade <br />i. Date (mmlddlyyyy) <br />j. Amount <br />k. Required Remarks <br />'D'r"t <br />a•r/;�� 14 <br />4. Payee lofortnation ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />include ci , state, & ' <br />b. Coordinated Committee Name <br />d. Comments <br />S e aY.IP •w—� [h :+ l:.n oc► <br />6c) R' aA RUL) <br />CD nGC y-j' 9 C Ag0all <br />qc4-jSV- 344 / <br />c. Level registered (Specify) <br />❑ Federal ❑ County: <br />❑ State ❑ Municipality: <br />e. Election Sam to Date <br />$ 16100 <br />f. Account Code <br />g. Form of Payment <br />h. Purpose Code <br />i. Date (molddlyyyy) <br />j. Amount <br />k. Required Remarks <br />1 <br />0/1:- 1 ao:a 4 <br />$ E.C- <br />-Bc v& Fees <br />"� r 1 IV !!L7 n4 <br />1'$ l :­1 <br />— <br />4. Pa ee Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />include ci , state, & <br />b. Coordinated Committee Name <br />d. Comments <br />state_ Er."*re—S cxeA t+ Vlnian <br />6r�, ^-� <br />0 Ral f D Dy NO <br />Co rV-0-;I- % G a ROA` <br />7° -- 799- 344-4 <br />s~ Level Registered (51�tr) <br />❑ Federal County: <br />state ❑ Municipality: <br />C. Election Sum to Date <br />1� " <br />E Account Code <br />g. Form of Payment <br />h- Purpose Code <br />L Date (mmAkVyyyy) <br />j. Amount <br />IL Required Remarks <br />t <br />O <br />l t 1 <br />1. p U <br />1 <br />-bn .t 1 6 l� I i ��•� -} 1.00 �. <br />Page $ .00 <br />5. Total on!this <br />6. Total of ALL CRO-131 a Pages <br />(This 6aegoes in lime 13a of DamikdSummory Page CRQII06if Open ft F. es) <br />(This lint goes in Now 13b of DeiaAW &mmrrry Page CR0L11W if Cbrmib to Co:n&daftVFoGv+iW Cameo <br />{This Crr►egaes in line 13r afDbpuslesd Suntrnary Purge CRO-I10e9 if Cooed Pany EVmddures} j <br />7. Pumose Codes(List detailed expenditure code in above} <br />A* - Media B* - Printing C* - Fundraising D - To Another Candidate <br />E - Salaries F* - Equipment G - Pcditical Party HP —Holding Public Office expenses <br />1 - Postage 3 - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fond <br />0* - Other <br />* Codes require detailed explanation in r aired remarks field } <br />CRO-1310 NC State Board of Elections December 2009 <br />