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Amendment <br />Disbursements ❑ Yes F3Na <br />Use this form to report expenditures from the committee for operating expenses, contributions to candid ate/pa litic al <br />committees and coordinated nartv expenditures <br />1. ommittee FuH Name and Fund if applicable) <br />2. ID Number <br />�tx� tr �+ � � �G �•� �'�j j t-l-- S `.IE'�1:1., •... � �1.`r � <br />--- - _ _ _ ---- — --- —___ <br />3. Type of Disbursement Ome use separate CRO-1310}onnsfor each type of Disbursement.), <br />Operatig Ea ses _Q Contributions to CandidateslPoliitical Committees Coordinated Ex endhres ' <br />. Payee Information E3 Add ORemove <br />a. Full Name, Mailing Address & Phone <br />include city, state, &rr zip) <br />b. Coordinated Committee Name <br />d. Comments <br />- <br />�Q1° t 1,s2.�lj'F'�'1C wk- <br />r] LII fcc A 1 -5�" ii <br />S ftt n �re ��l Cr ,2!?f6-3 <br />'70r.2 -739 <br />e. Level Roistered (Specify) <br />Federal County: <br />❑ state ❑ monicvaiity: <br />e. F:leelion Sum to Date <br />$ <br />Account Code <br />g. Forms of Payment <br />Is. Purpose Coke <br />L Date (mmlddlyyyy) <br />' Amouaimt <br />k. Required Remarks <br />e { <br />d `j ;t� .to.Z 3 <br />$ to. - <br />L <br />$ <br />. Payee Information OAdd 0 Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Coordinated Committee Name <br />d. Comments <br />mad r o+n <br />t `2 GcocLrn�n <br />Q p"' ! + 1A C <br />a0� ASO-4951 <br />e. Level Registered (spedlsr) <br />Federal M County: <br />❑ state ❑ Municipality: <br />e. Election Sum to Date <br />$ 3a. W7 <br />f. Account Code <br />g. Form of Payment <br />b. Purpose Code <br />i. date (mmlddlyyyy) <br />J. Amount <br />L Required Remarks <br />�e.So ti <br />1010112.0xtr <br />$ 3 8 .o 7 <br />" ar t i s <br />. Payee Information ❑ Add ❑ Remove <br />Full Name, Mailing Address & Phone <br />(include city, state, & up) as <br />15 <br />+ 105 �j te,;5- L a yw— <br />104 -- IT? 1 3100 <br />b. Coordinated Committee Name <br />d. Comets <br />c. Level Registered (Specify) <br />Fcdcrz County: <br />❑ State '❑ Municipality. <br />le. Election Sues to Date <br />1 <br />1 $ 175 ,°! <br />Account Cade <br />g. Form of Payment <br />b. Purpose code <br />L Date (umalddlyyyy) <br />10 ob ao-1S <br />' Amount <br />$ 175. n % <br />k. Required Remarks <br />deb i )r <br />S. Total only this Page $ O <br />6. Total of ALL CRO-1310 Pages - <br />(This line goes in line 13a of Retailed Summary Page CRO-1100 if Operating Expenses) $ <br />(This line goes in line 13b of Retailer! Summary Page CRO-1100 if Coutrih to CandidateslPolitical Comm) <br />(This line goes in Une 13c of Detailed Summary Page CRO-1100 if Coordinated Party Expenditures) <br />. ftrpoSe Coots (List detailed expenditure code in (h.) above) <br />Media B* - Printing C* - Fundraising D - To Another Candidate <br />- Salaries F* - Equipment G - Political Party H* - Holding Public OtTlce Expenses <br />- Postage J - Penalties K* - Office Expenmz Q* - Donation to Legal Expense Fund <br />* Other <br />* Codes require detailed explanation in required remarks field W <br />CRO-1310 NC State Board of Flectious December 2009 <br />