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Contributions from Individuals <br />Pg 3 of <br />Use this form to report individual contributions over $50 or contributions under $50 if form CRO <br />iAmendmeut ---- <br />❑ Yes_ _® <br />1205 is not used <br />1. Committee Full Name (and Fund if applicable) <br />2. ID Number <br />BAILEY FOR CABARRUS <br />CAB-R$1N22-C-001 <br />3. Contributor Information <br />❑ Add .. ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, &zip) <br />b. Job TitletProfession <br />d. (:omments <br />SECURITY OFFICER <br />JOSEPH TIERNEY <br />724 FOXWOOD DR SW <br />CONCORD, NC 28025 <br />c. Employer's Name/Specific Field <br />ROWAN-CABARRUS CMTY <br />COLLEGE <br />e. Election Sum to Date <br />$ 250.00 <br />f. Prior <br />jg.AecounlCode <br />h. Form of Payment <br />i. Iu-Kind Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />Ql <br />Check <br />10I1512025 <br />$ <br />250.00 <br />4. Total only this Page <br />$ <br />250.00 <br />5. TOW of ALL CRO-1214 Pages <br />(This line must lie on line b ofAetailed Summary Page CRO-1100) <br />4,25Q.00 <br />CRO-1210 NC State Board of Elections April 2007 <br />