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Amendment - -- <br />Disbursements Pg of ❑ Yes ❑ ND <br />Use this form to report expenditures from the committee for operating expenses, contributions to candidate/political <br />committees and coordinated party expenditures <br />1. Committee Full Name (and Fund if applicable) <br />�r <br />2. ID Number <br />3. Type of Disbursement (Please use separate CRO-1310 forms for each type of Flisbursement.) <br />QrOperating Ex cnses Contributions [oCandidatesfPolitical Committees U Coordinated Party E.X[lCMiiturcS <br />. Payee Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />include city, state, & zip) _ <br />�� $ Pf �� '� �� <br />��+d cfi r7Ly a6p1 / <br />b. Coordinated Committee Name <br />d. Comments <br />c. Level Registered (Specify) <br />❑ Federal County: <br />❑ State ❑ Municipality: <br />e. Election Sum to Date <br />$ <br />. Account Code <br />t�k- <br />g. Form of Payment <br />cam; <br />h. Purpose Code <br />i. Dale tmadddh,}yy) <br />Iz` <br />J.Amount <br />.. • ° <br />�3 <br />k. Required Remarks <br />.°iI�L �� <br />e 4� <br />s <br />. Payee Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Coordinated Committee Name <br />d. Comments <br />c. Level Registered [Specify) <br />❑ Federal ❑ County:Elstate [I Municipality: <br />e. Election Sum to Date <br />. Account Code g. Form of Payment <br />h. Purpose Code <br />i. Date (mmlddlyyyy) <br />. Amount <br />L Required Remarks <br />S <br />4. Payee Information ❑ Add ❑ Remove <br />Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />I). Courdinated Committee Name <br />d. Comments <br />c. Level Registered (Specify) <br />Federal El County: <br />❑ state ❑ Municipality: <br />e. Electlon Sum to Date <br />$ <br />. Account Code <br />g. Form of Payment h. Purpose Code <br />..........._._ <br />d. Date (mmlddlyyyy) <br />... ........ ............ <br />j.o Amunt <br />IL Required Remarks <br />. Total only this Page <br />. Total of ALL CRO-1310 Pages <br />(This lute goes in line Ida of Detiled Summary Page CRO-1100 if operating Expenses) <br />(This line goes in line 13b of Detailed Summary Page CRO-1100 if Contrib to CandidareslPoliriral Comm) <br />(This line goes in line 13c o Detailed Sumnwry Page CRO-1100 if Coordinated Party Expenditures) <br />$ <br />. Purpose Codes (List detailed expenditure code in (h.) above) <br />* - Media B* - Printing C* - Fundraising D - To Another Candidate <br />E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses <br />- Postage J - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund <br />O* Other <br />* Codes require detailed explanation in reiluired remarks field W <br />UK()-! 410 NC State Board of Elections December 2009 <br />