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Amcndnrent <br />Contributions from Individuals Pg of ❑ Yes ® No <br />Use this farm to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used <br />1. Committee Full Name (and Fund if applicable) <br />2. ID Number <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Job Title/Professinn <br />d. Comments <br />,++ it <br />C+ o rn;dim d� V L+�7 <br />ry <br />fo' -- VE�B- Xo4r7 <br />c.Employer's 311mdSpecifir Field <br />�>� <br />e. Election Sum to Date <br />$ (7p <br />.Prior <br />g. Account Code <br />b. Form of Payment <br />i. In -Kind Description <br />j. Date (mrdddlyyyy) <br />k. Amount <br />CAI +3laoa& <br />$ 100 <br />❑ <br />$ <br />Contributor Information ❑ Add ❑ Remove <br />Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Job Title/Profession <br />d. Comments <br />3)Y <br />5G�D Yrish �o� <br />70 - 791-asqci <br />c. Employer's Name/Specific Field <br />e. Elecd ni Sum to Date <br />$ ISO VO <br />Prior <br />ig.AccoluntCode <br />h. Form of Payment <br />i. In -Kira] Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />j <br />Cheer <br />1 eta <br />$ <br />$ <br />❑ <br />❑ <br />$ <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Job Title/Profession <br />d. Comments <br />� ► - • Y <br />�7 <br />R. S1E <br />(00 R4 Vl [[4-1,-- DY ta <br />'C 0 tic.bvClk, N c a `r c)W7 <br />78.3 - 73a1 <br />c. Employer's Name/Specific Field <br />044cN- <br />e. Electioa Sum Date <br />$ /'V a0 <br />Prior <br />g. Aeeount Code <br />h. Form of Payment <br />i. In -Kind Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />CE`N�G <br />�t�bl� o (o <br />$ fa6, <br />❑ <br />$ <br />❑ <br />$ <br />4. Total only this Page <br />$ b mO <br />5. Total of ALL CRO-1210 Pages <br />(Thus dine must be on line b of Detailed 5untinary Page CRD-1100) <br />$ ,1OC m <br />']' <br />CRO-1210 NC State Board of Elections April 2007 <br />