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Disbursements Amendment <br />of ❑ Yes [ No <br />Use this form to report expenditures from the committee for; operating expenses, contributions to candidatelpoliticai <br />committees and coordinated party exnenditu es_ <br />1. Committee Full Name and Fund ifs licable 2. ID Number <br />e e» is Qec-A o C <br />3. Type of Disbursement Please use s orate Ck 0-1310 fogm for each o Disbursement <br />® Operating Expenses ❑ Contributions to Candida m'Political Committees ❑ Coordinated Party Eapcnditures <br />4. Payee Information El Add Remove <br />a. Full Name, Mo '"hag Address & Phone <br />include city,state, & <br />b. Coordinated Committee Name <br />d. Comments <br />a � Emolcyees�res��} <br />b0 + � o,� `i�r ni �: <br />7AL 1 s18- 314-14 <br />c. Lewd Registered (Specify) <br />❑ Federal ❑ County: <br />❑ state ❑ Municipality: <br />e. Election sum to Date <br />_ <br />f. Account Code <br />g. Form of Payment <br />h. Purpose Code <br />L Date {mntlddlyyyy} <br />j. Amount <br />k. Required Remarks <br />A c ate- <br />i �� <br />- �� <br />S � . LOto <br />:. <br />4. Pa ee Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />include city, state, & 2i <br />b. Coordinated Committee Name <br />d. Comments <br />s+a.�pC�77Qlocge s C�►ref� �{ U.n lac► <br />n - ss <br />W nw1rd, u C.. Ascarl <br />r.l.ertl tered <br />> (Specify) <br />❑ Fe& aI ❑ County: <br />❑ State ❑ Municipality: <br />e. Election Sum to Date <br />$ /0700 <br />f. Account Code <br />g. Form of Payment <br />b.Purpose Code <br />L pate (mutlddlyyyy) <br />j. Amount <br />L Required Remarks <br />1 <br />t <br />o <br />3 / 1 .�,� <br />$ ! • °C' <br />°4 10 S <br />$ � UO <br /><< <br />4. Payee Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />include ci , state, & a <br />b. Coordinated Committee Name <br />d. Comments <br />t(e_ rp�l�ees Cc�. `�� llr. � ❑n <br />60 j <br />'�t7� -aw <br />Co r w o� l 4 6 NollI <br />1D+— 783" <br />red (specify} <br />Level"a1 <br />E]Federal ❑ Comity: <br />❑ State ❑ Municipality- <br />e. Election Sum too Date <br />to <br />E Account Code <br />g. Form of Payment <br />h. Purpose Code <br />L Date [mmlddlyyyy] <br />j. Amount <br />k. Required Remarks <br />t <br />o <br />15 0C/ !r O.Z5- $ �• vej <br />Page <br />S. Total nnl this <br />$ c <br />6. Total of ALL CRO-1310 Pages <br />(Tkis finegoes in Brae 134 ofada" Snrwmwy Page CRt9-1100 if Operating Erpenm) <br />(This lYire goer in fine 13b of 1?eiaaiW shmmary Page cw-IIOU if Coto wb to cwmdwwewFv&jad Corm $ <br />(This line gaff in line Me ofDk!W xf Sunraraay Page CR&1100 if Coordbutted Panty &pmAwrm) � <br />7. PuMow Codes (List detailed 2221diture code in (h.) above) <br />A* - Media B* - Printing C* - Fundraising D - To Another Candidate <br />E - Salaries F* -Equipment G - Pc4itical Party W-Molding Public OMce Expenses <br />I - Postage d - Penalties K* - Office Expenses Q* - donation to Legal Expense Fund <br />O* - Other <br />* Codes require detailed explanation in 2quired remarks field (k) <br />CRO-1310 NC State Board of Elections December 2009 <br />