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In -Kind Contributions <br />Pg <br />Amendment <br />of ❑ Yes ❑ No <br />Use this form to report non -monetary contributions, donations, goods or services provided to <br />the committee or fund. <br />Use CRO-1215 if In -Kind Contributions were or will be refunded within 7 da s. <br />1. Committee Full Name (and Fund if applicable) <br />2. ID Number <br />3. Contributor Information ❑ <br />Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />b. Type of Cuntriholor <br />c. Comments <br />(include city, state, & zip) � <br />Individual <br />ti <br />3 s'� 7 aS H�'y G,al f/1� <br />❑ Candidate <br />- �?O �-3 r <br />❑ Party <br />❑ PAC <br />f ��l;t r,d y r� <br />❑ Referendum <br />❑ Other Receipt Source <br />d. Election Sumjt,jj <br />$ fr6� d <br />e. Description - <br />f. Date (mmlddlyyyy) g. Fair Ma <br />4'V1 <br />y <br />��jrl�.Sf $ ��• <br />R <br />T <br />$ <br />3. Contributor Information ❑ <br />Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />b. 'type or Contributor <br />c. Comments <br />(include city, state, & zip) <br />Individual <br />❑ Candidate <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />d. Election Sum to Date <br />❑ Other Receipt Source <br />e. Description <br />f. Date (mrnlddl yyyy) g. Fair Market Amount <br />5 <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />b. Type of Contributor <br />c. Comments <br />(include city, state, & zip) <br />❑individual <br />~ <br />❑ Candidate <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />d. Election Sum to Date <br />❑ Other Receipt Source <br />e. Description <br />f. Date (nun/ddlyyyy) g. Fair Market Amount <br />1$ <br />4. Total only this Page <br />C" � a <br />5. Total of ALL CRO-1510 Pages <br />(This fine must be on line 17 of Detailed Summary Page CRO-1100] <br />CRO-1510 NC State Board of Elections <br />December 2UO7 <br />