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Amendment <br />Other Receipt Sources Pg of ❑ Yes ❑ No <br />Use this form to report income not reported on another form. i.e. interest income, not for profit contributions etc. <br />1. Committee Full Name and Fund if applicable) <br />2. ID Dumber <br />3. Type of Receipt Source (Please use separate CRO-1250 foram Lor each type ofReceipt Source.) <br />Interest ❑ Coniribulious from Not -for -Profit Organizations ❑ Outside Sources of Income <br />4. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Nut -fur -Profit Federal ID # <br />d. Comments <br />���}� � cnPt_o` iFiF CK g ❑I r �,2.1 "10 N <br />{ —{� , +� j , , r <br />60 R1cJ jYd .1Y (V W <br />�m Y1eo Td t N 0— a QiSa�� <br />q04 793 --344v <br />c. Outside Source Explanation <br />e. Election Sam to Date <br />f. Account Code <br />g. Form of Payment <br />h. In -Kind Description <br />L Date (mmlddtyyyy) <br />j. Amount <br />i <br />1 <br />]Dpmr- r <br />Jl t i1 F--r <br />1n-koye4- ()y�Cth�% <br />Y h �1Y�.�i 11 <br />°7 !� x> a� <br />�` • !`� <br />0113 � c: 5 <br />$ f '7�' <br />4. Contributor <br />Information ❑ Add I ❑ Remove <br />a. Full Name, Mailing Address & Phone � <br />(include city, state, & zip) <br />h. Not -for -Profit Federal ID # <br />d. Comments <br />U�► { ' <br />S fCL. G mN oyjaes ``ty Ir i art <br />G� Di`ez` ' L- a��0, `i <br />a outside Source Explanation <br />c. Election Sum to Date <br />_. <br />C Account Code <br />g. Form of Payment <br />h. In -Bind Description <br />i. Date (mmlddlyyyy) <br />j. Amount <br />-DgP,rr <br />T ro• r T <br />fir,- resf 0,n C NW_V\ i n <br />-ri4a "t o n ae X i n <br />09 1 1t b'oa5 <br />10 ] 13 I;.o 2T <br />4. Contributor Information ❑ Add <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />❑ Remove <br />h. Not -for -Profit Federal ID # <br />d. Comments <br />s. e, f- n+rPLo Yak S CAJa I r iANI otl <br />Yd -DY H W <br />Co ncc�v�d ,Nye. A Soap <br />Rl ? S 4 + 7 + , <br />c. Outside Source Explanation <br />e. Election Sum to Date <br />f. Account Code <br />g. Form of Payment <br />h. In -hind Description <br />i. Date (mmlddlyyyy) <br />j. Amount <br />1 <br />"bra-�'�anre.s� <br />onneacti�� <br />l ti a►a�5 <br />$ 7� <br />5. Total only this Page <br />6. Total of ALL CRO-1250 Pages I� <br />(This line goes in line ]]a of Detailed Su► wwU Page CRO-1100 if Interest) i <br />(This line goes in line I l h of Derailed Su► wwry Page CRO-1100 if Nof for-Prefrt Contribution) <br />(This line goes in line Ile of Derailed Summary Page CRO-1100 if Outside Sources oflncome) <br />CRO-1250 N[' State 13011rd of HCCHons December 2007 <br />