Laserfiche WebLink
Amendment <br />In -Kind Contributions Pg of ❑ Yes ❑ No <br />Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund. <br />Use CRO-1215 if In -Kind Contributions were or will be refunded within 7 days. <br />1. Committee Full Name (and Fund if applicable.) <br />2. 11) Number <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name. Mailing Address & Flione <br />h. I ype or Contributor <br />V. I'umrnent. <br />(include city, state, & zip} <br />c�i •, (� •� ti �a� 6 <br />3 7 w ���� y ��` S+r. <br />❑ Individual <br />❑ Candidate <br />❑ Party <br />❑ PAC <br />_ <br />❑ Referendum <br />❑ other Receipt Source <br />d. Election Sum to Date <br />$ <br />Description <br />f. Date (mmlddlyyyy) <br />g. Fair Markct Amount <br />$ <br />$ <br />3. Contributor Information Add 13Rernove <br />a. Full hams, Mailing Address & Phone <br />b. Type of Contributor <br />C. Comments <br />(include cite, state, & zip) <br />❑ Individual <br />❑ Candidate <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />d. Election Sum to ]late <br />❑ other Receipt Source <br />$ <br />e. Description <br />f. Dale inunlddlyyy}) <br />g. lair Markel Amipum <br />5 <br />. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />b. Type of Contributor <br />c. Comments <br />(include city, state, & zip) <br />❑ Individual <br />❑ Candidate <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />d. Eteetion Sure lu Date <br />❑ Other Receipt Source <br />$ <br />Description <br />f. Date (mmlddlyyyy) <br />g. Fair Market Amount <br />$ <br />4. Total only this Page <br />$ o'' •s" <br />5. Total of ALL CRO-1510 Pages <br />$ <br />(This dine mrist he on line 17 of Detaided Summary Page CRU-1100) <br />CRO-1510 NC State Board of Elections December 2DO7 <br />