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Amendment <br />Contributions from Individuals Pg of 7 ❑ Yes ❑ No <br />Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used <br />1. Committee Fuil 1Vame and Fund if applicable) <br />ID Number <br />-V ��C:s::.-f �i i:.. ^� lkaos 0 e-r lei <br />CO2. <br />CLA <br />3. Contributor Information ❑ <br />Add ❑ Remove <br />a. Fall Name, Mailing Address & Phone <br />b. dolt TiddProfession <br />d. <br />Comments <br />(include city, state, & zip) <br />S E sfc:Y�t►`r <br />c. Employtr's NamelSpecifiic Field <br />� <br />4o(,13rlshn - c,6 Ko A <br />+ <br />EIl V r rrert auk LanMD <br />e. Election <br />Snm to date <br />$ ' <br />va/ 500 <br />f. Prior <br />g. Account Code <br />b. Form of Payment <br />i. In -Kind Description <br />j. Date (mmldd/yyyy) <br />IL Amount <br />❑ <br />C.i44C K <br />3. Contributor Information ❑ <br />Add ❑ Remove <br />a. loll dame, Mailing Address & PWmc <br />b. Job Title/Profession d. Comments <br />{include city, state, & zip) <br />C4AkLE-S C , c)LvDi�N <br />la Employer's NameSi <br />ti7CJr_ �• <br />� , � [� ,�" � e. Election Sum is Date <br />�l <br />�o413 <br />f <br />0Lr . <br />f. Prior g. Account Code 4. Form of Payment f. In-K{ind Description j. Date (mmlddiyyyy) <br />L Amount <br />❑ i G REL'-K <br />$ <br />❑ <br />$ <br />❑ <br />$ <br />3. Contributor Information ❑ <br />Add ❑ Remove <br />a. Full Name, Mailing Address & Prone <br />b. Job Title/Profession d. Comments <br />(include city, state, & zip) <br />EY VIC-1 .1Y�]iI <br />c. Employtes Name/Specific Field <br />1t�Di <br />¢ a 9081 <br />, c. Election Sum to Date <br />l t�c.� it <br />r� �r <br />f. Prior g. Account Code b. Form of Payment i. In -Kind Description j. Date (mmhidlyyyy) <br />L Amount <br />❑ r <br />$ <br />❑ <br />$ <br />❑ <br />$ <br />4. Total only this Page <br />5. Total of ALL CRO-1210 Pages <br />M� fine must be on line 6 of Detailed surroawy Page CRO-rrvo) <br />$ <br />a..nv-.1161U NU State board of Elections April 2007 <br />