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Contributions from Individuals <br />Amendment <br />Pg or ❑ Yes ❑ No <br />Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not useei <br />1. Committee Full Name (and Fund if applicable) <br />2. ID Number <br />3. Contributor Information 0 Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />b. Job Title/Profession <br />d. Comments <br />(include city, state, &xip) <br />Employer's NamelSpecific Field <br />O <br />e. Election Sum to Date <br />.Prior <br />g. Account Code <br />b. Farm of Payment <br />i. In -Kind Description <br />'. Date (mm/dd/yyyy) <br />k. Amount <br />❑ <br />Gc��O_Ibb <br />2- <br />Nl Si=E F'l <br />l"1 I Za Z <br />❑ <br />7 <br />0-Se - �� �x <br />z 1 � <br />zA zs- <br />po <br />s <br />'Bow <br />z � z—z- <br />2 <br />. Contributor Information ❑ Add ❑Remove <br />• . Full name, Mailing Address & Phone <br />b. Job Title/Profession <br />d. Comments <br />(include city, state, & zip) <br />3.J� `—�� S • " ' � <br />c. Employer's Name/Specific Field <br />Y5 3y�,���. <br />1� <br />e. Election Sum to Date <br />$-rr_��IF—) <br />.Prior <br />g. Account Code <br />h. Form of Payment <br />i. In -Kind Description <br />j. Date fmmldd/vyyy) <br />k. Amount <br />❑ <br />CZ <br />ti Z y 2 <br />a <br />❑ <br />S <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />b. Job Titleftofession <br />d. Comments <br />(include city, state, &xip) <br />r. Employer's Name/Specific Field <br />e. Election Sum to Date <br />Prior <br />g. Account Code <br />h. Form of Payment <br />L In -Kind Description <br />'. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />$ <br />❑ <br />$ <br />❑ <br />$ <br />4. Total only this Page <br />$ p ' <br />5. Total of ALL CRO-1210 Pages <br />line be line Detailed Summary Page C'RO-1100) <br />$ <br />(This must on 6 of <br />[:RO-121 U NC State Board of Elections April 2007 <br />