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Contributions from Individuals <br />Amendment <br />Pg of ❑ Yes ❑ No <br />Use this form to report individual contributions over $50 or contributions under $ 5 0 if form CRO 1205 is not used <br />I. Committee Full Name (and Fund if applicable) <br />Gee- <br />2. ID Number <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Job Title/Profession <br />d. Comments <br />Re -rt' 9 <br />I LAeifMtYV-1 b <br />[I�01'/C'0,0-(4 F iv(2 : <br />317-W43-4)i?�7 <br />e. EmpIoyer's Name/Specific Field <br />l , <br />e. Election Sum to Date <br />$ !_it�°l ifv <br />Prior <br />g. AecouVt Code <br />h. Form of Payment <br />i. In -Kind Description <br />J. Date (mmlddlyyyy) <br />k. Amount <br />[3 <br />MONO I <br />iL_1.0 Ct <br />$ <br />❑ <br />$ <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Flailing Address & Phone <br />(include city, state, & zip) <br />b. Job'ritlelProfcssion <br />— - <br />t <br />- q <br />L I 3 2026 <br />c. Employer's Name/Specific Field <br />CAS <br />BOAR <br />_ <br />� F ELECTIONS <br />,.Prior <br />g. Account Code <br />h. Form of Payment <br />i. in -Kind Description <br />j. Date (mm/ddlyyyy) <br />k. Amount <br />$ <br />❑ <br />❑ <br />$ <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Job Title(Profession <br />it. Comments <br />e. Employer's Name/Specific Field <br />e. Election Sum to Date <br />Prior <br />g. Aoeount Code <br />h. Form of Payment <br />i. In -Kind Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />$ <br />❑ <br />$ <br />❑ <br />$ <br />4. Total only this Page <br />$ 3 <br />5. Total of ALL CRO-1210 Pages <br />[7his line must be on &ne 6 of Detailed Summary Page CRO-II00) <br />l <br />■ - <br />CRO-1210 NC Slate Hoard of Elections April 2007 <br />