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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 $50 if form CRQ 1205 is not used <br />t. Committee hull Name {and Fund if applicable} <br />2. ID Number <br />3. Contributor Information ❑ Add ❑ Remove <br />it. Full Name, Mailing Address & Phone <br />(include city, state, & xip) <br />�y <br />COa. ' `. z ?d <br />'3 C-i?1Z.A J <br />b. Job TitlelProfession <br />d. Comments <br />c. Employer's NamelSpecific Field <br />( <br />��.1<<IJ:S <br />e. Election Sure to Date <br />.Prior <br />g. Account Cade <br />h. Form of Paymeut <br />L In-Kiud Description <br />J. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />U I <br />CL4 : <br />�et�tt <br />! ���s. ZdLi <br />$ $ ty, <br />3. Contributor Information ❑Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, stage, & zip) <br />h. lob TitlelPrafession <br />d. Comments <br />c. Employer's Name/Specific Field <br />e. Election Sum to Dille <br />Prior <br />g. Account Code <br />It. Form of Payment <br />1. In -Kind Description <br />j. Date (nunlddlyyyy) <br />It. Amount <br />❑ <br />$ <br />❑ <br />$ <br />❑ <br />$ <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />h. Job Title/Profession <br />d. Comments <br />c. Employer's NamelSpeclPie Field <br />e. Election Sum to Date <br />$ <br />f. Prior <br />g. Account Code <br />h. Form or Payment <br />1. In -Kind Description <br />j. Date (tmnlddlyyyy) <br />k. Amount <br />❑ <br />$ <br />❑ <br />$ <br />❑ <br />$ <br />4. Total only this Page <br />$ 1 ) i <br />S. Total of ALL CRO-1210 Pages <br />(This line mast be online b of Nlailed Summary Page CRO-1100} <br />$ <br />CRO-1110 yf S1;ne lioiird of Elections April 2007 <br />