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Contributions from individuals Amendment <br />!'g of ❑Yes Nn <br />Use this form to report individual conlribotions over $50 or contributions under $50 if forfn C:RO 1205 is not us <br />t. Pill! dame, Muitiog Addrm & Fhume <br />i nrludc city, <br />Prior : of Paywemt <br />— ...........---....... <br />. <br />° kRd <br />hull Name, Mailing Address & Phone <br />(include city, Aatc. & 4p) <br />AreountCode <br />`71+ SC70 <br />li. Jab Tida Pteression d_ Comments <br />O Lo Lr <br />c. Unpioyer'ss jNaanx-Apecidir Field <br />e. Electi„u sum to hate <br />f,'arrs $ <br />iA xiea nesrripriAn •. DAC (otrddduyyyy) L A, x)=t <br />---._.......... <br />. ___.._......._._- . <br />'20. Ja1,a1X2 $ 7a+ 7q <br />r <br />r alr71o5 $ 13 4, �sF <br />m Jon AnwrrOtLS!'iNII <br />d. C.omummts <br />G Kex lnyer'ssNN�ay WPVecifiir Field <br />853 r T <br />i. Form of Payment i. tn"Kind inscription datmu� <br />e (nmttl } lL Ao,t <br />r , <br />�"n--1C��9C. C�YCaC 5J nsVPI <br />!a 17�a¢a5 $ LrS. DrD <br />err--0�"nOC. are,! ao <br />-N%iiing Address & Phone b. <br />(Welude city, state, 8F- <br />5u,5an &4r-, C. <br />,P3 'Box laa5 <br />j(�1n/iSJ Ifs - <br />Prior g ArcEwat Code h. Form or Payment Lin -Kind Desciiptioi <br />❑a <br />Al <br />anb r;tf,ulP.�re�A <br />Employer's NanWSPecifir FieW <br />NI� e. Ekrtian �a W I�tRe <br />j. Elate (BuWddlyyyy) L Aawmt <br />---- - ..... <br />f�1 81xa5 $ 191.76 <br />$ <br />C'RO-121 Q XC state BoaW of Elections April 2007 <br />