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In -Kind Contributions <br />Amendment <br />Pg of ❑ Yes ❑ No <br />Use this form to report non -monetary contributions, donations. goods or services provided to the committee or fund, <br />Use CRD-t215 if In -Kind C'ontr'ibmion- were or will hr• rr.fisncled within 7 nave <br />1. Committee Full Name (and Fund if applicable) <br />2. ID Number <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) P) <br />5-ze f NA-t657-PL- A-6 <br />[lt 0jG6r N c—� S <br />b. Type of Contributor <br />ndividual <br />Candidate <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />❑ Other Receipt Source <br />c. Comments <br />d. Election Sum to Date <br />$ <br />e. Description <br />1vffrT <br />f. Date (nunlddl yyyy) <br />irJ-2��2oy� <br />g. Fair Market Amount <br />"A-C(, A457" <br />1[ Zq�yo�S� <br />$ ram• `�D <br />kX4$erj� SOD <br />$ g¢'��' <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />y 7o ttA,' tfj7� ,4} - <br />MILS&11�_' N C 2—$o-1 5 <br />b. Tape of Contributor <br />Individual <br />❑ Candidate <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />❑ Other Receipt Source <br />c. Comments <br />d. Election Sum to Date <br />$ <br />'. Description f. Date (mndddlyyyy) <br />g. Fair Market Amount <br />$ <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />1). Type of Contributor <br />c. Comments <br />❑ Individual ~ Y <br />❑ Candidate <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />❑ Other Receipt Source <br />d. Election Sum to Date <br />$ <br />e. Description <br />f. bate (mndddlyyyy) <br />g. Fair Market Amount <br />4. Total only this Page <br />$)/f?0.31 <br />5. Total of ALL CRO-1510 Pages <br />(This line mast be on line Hof Detailed Summary Page CRD-1100) <br />$ y <br />LHO-1 'Ju NC State Board of Electioms December 2007 <br />