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In -Kind Contributions <br />Amendment <br />pg of ❑ Yes ❑ No <br />Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund. <br />Use CRO-1215 if In -Kind Contributions were or will be refunded within 7 days. <br />1. Committee Full Name (and Fund if applicable) <br />2. ID Number <br />j <br />.._..................................................... <br />3. Contributor Information U Add U Remove <br />a. Full Dame, Mailing .address & Phone <br />b. Type of Contributor <br />c. Comments <br />(include city, state, & zip) <br />t,jF I ( At, <c- w , J <br />��p �, grrj ��� NCB <br />13 Individual <br />❑ Candidate <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />d. Election Sum to Date <br />❑ Other Receipt Source <br />$ <br />e. Description <br />f. Date (mmldd/yyyy) <br />S- Fair Market Amount <br />Sj�t1 <br />1%^l7.xifr <br />$ 30�ri" <br />$ <br />3. Contributor Information ❑ Add ❑ Remkivt <br />• . Full Same, Mailing Address & Phone <br />h. h pc lot Cont rihuku <br />V. Comments <br />(include city, state, & zip) <br />❑ Individual <br />❑ Candidate <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />d. Election Sum to Date <br />❑ Other Receipt Source <br />$ <br />Description <br />f. [late (nunlddlryyy) <br />g. Fair Market Amount <br />$ <br />Contributor Information ❑ Add ❑ Remove <br />Full Name, Bailing Address & Pitane <br />b. Ty pe of Contributor <br />c. Comments <br />(include city, state, & zip) <br />❑ Individual <br />❑ Candidate <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />d. Election Sum to Date <br />❑ Other Receipt Source <br />$ <br />e. Description <br />f. Date (nmtlddlyyyy) <br />g. Fair Market Amount <br />$ <br />4. Total only this Page <br />$ <br />5. Total of ALL CRO-1510 Pages <br />(This line must &r an Bite 17 of Detailed Sunjmary Page CRO•I100) <br />$ . 7- 1�71 <br />CRO-1510 NC State Board of Elections December 2007 <br />