Laserfiche WebLink
Amendment <br />In -Kind Contributions t'g _ of ❑ Yes ❑ No <br />Use this funn to report neon -monetary contributions, donations, Kurds or services provided to the cotntnittee or fund. <br />Use C'R0 121 5 iF Iri Kind Contrihtaksn� were or «•ill he refunded tirithin' iiaAti. <br />1. Conimitteg Full Name (and Fund ii' applicable) <br />2. iD Number <br />Ca .�.�-. , r, ck� -1 to C rw �— � 73 ti� I C t U- <br />3. Contributor Inrorntation LJ Add Remove <br />F u11 Manic, ]tailing Address & I'll une <br />b. t rpe of Contrihutnr <br />c. Comnlcnts <br />(include city, state. & zip) <br />© hnlividual <br />❑ ('andidatr <br />❑ v:\C <br />rj .tom. LFOV) <br />❑ Rcfmodum <br />d. Election Sum to [laic <br />❑ Other Receipt Source <br />5 <br />lkacriptiurr <br />f. [late (mrnlddlyyyy) <br />g. Fair Market Amount <br />�t7A.va of t}L4t:V•0-A <br />tI. UP taxi <br />�O <br />�'A,. �_,� U�� srIX <br />it- t0Z' <br />w 4� <br />;. Contributor Information ❑ Add El Remove <br />a. Full Name. %[ailing Addres% K Phone <br />b. 1 ypr of Contributor <br />V. i'ununeer[s <br />(include city, st:de. & zip[ <br />❑ individual <br />❑ Candidate <br />❑ 1'�jrty <br />❑ PAC <br />❑ kci'Crvndurn <br />d. Election Sam to Bate <br />❑ r jl'ller Rccc l pt Stwvc <br />----- _ <br />tleuription <br />L Date (nunlddlyyyy) <br />g, hair Market Amount <br />3. Contributor Information El Add El Remove <br />t. Full %ame, Mailing Address & 11lronc <br />h. Type of Con tribuinr <br />C. conrnrrnt+ <br />[include city, ,tale. &aip, <br />❑ [ndi4idu:rl - ---- <br />❑ I'.�ny <br />❑ RJuendum <br />d. Election Sum to Date <br />❑ { Cher Receipt Source <br />5 <br />v. Description <br />f. ❑ate Inmrlddlyy}yl <br />g. Fair-NNrkrt Amount <br />Z <br />5 <br />4. 'Total only this Page <br />5. Total of ALL CRO-1510 Pages <br />w <br />(Tlrir lire rattrr he online 17 of Detailed Surrrraary• Page CR(141DI!) <br />y <br />i RO.1510 \{ Sr.ir � li,,,wd "r I i r ,,;,. lhcernbh r _'ilti' <br />