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Contributions from Individuals <br />Amendment <br />Pg of ❑ Yes ❑ No <br />Use this form to report individual contributions over $50 or contributions under S50 if form CRO 1205 is not used <br />1. Committee Full Name (and Fund if applicable) <br />2. 11) Number <br />ee � �-� A.17�-r t-_ Te,-, L'/r e'l/ X,-,-44 e-e-- <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Nailing Address & Phone <br />h. Job Title/Profession <br />d. Comment,, <br />(include city, state, & zip) <br />4..r1 �, y y Q* <br />c. Employer's Namc/Speeific Field <br />del 417 <br />� <br />�O•ij f <br />e. Election Sum to Date <br />r <br />H / d <br />r. prior <br />g. Account Code <br />h. Form of Payment <br />i. In -Kind Description <br />j. Date {mmld(llyysy) <br />L Amount <br />❑ <br />S <br />❑ <br />S <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />h..1oh'HtlelProfm,;ion <br />d. Comments <br />(include city, state. & zip) <br />,Qcrrt2. eJ <br />c. Employer's Name/Specific Field <br />i r-y <br />e. Election Sum W Date <br />$ <br />.Prior <br />g. Account Code <br />h. Form of Payment <br />i. in -Kind Description <br />j. Date Smndddlyyy'y) <br />k. Amount <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name. Mailing Address & Phone <br />h. Joh TitlelPrufcssion <br />d. Comments <br />(include city, state. & zip) <br />Employer's Name/Specifie (Meld <br />c. <br />e. Election Sum to Date <br />$ <br />'- Prior <br />g. Accoimt Code <br />h. Farm of Pu men[ <br />i. In -Kind Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />&'C <br />-f7 <br />/,I -3',f el <br />$ S 4, r <br />❑ <br />k. <br />A_,� /,�1►tJA <br />Pr, x�ls7 ►V <br />Al�y y <br />S ' 'S, <br />niu� <br />f <br />4. Total only this Page $ 1/4w- <br />5. TotaI of ALL C:RO-1210 Pages $ <br />(This line mast he an line 6 of Delailed Summery Page C'RO-1100) <br />CRO-1210 NC State Board of Elections April 2007 <br />