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Amendment <br />Contributions from Individuals Pg � of ❑ �'es 14 No <br />Use this form to revort individual contributions over $50 or contributions under $50 if form CRO 1205 is not used <br />I. Committee Full Name _(and Fund if applicable) _ <br />�G juex't :+w. `Cjjt�C'v65 �,1e•l Vi (.�c+c,�C <br />2. ID Number <br />3. Contributor Information ❑ Add ❑ Remove <br />Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />o l k,t e..vNe. - - <br />I i t7 Ft]Y e�� �- � � G� [-� NE <br />GQ ��cYd' NC <br />b. Job Title/Profession <br />d. Comments <br />Yeti i e.;;l <br />c. Employer's Name/Specific Feld <br />e. Election Sum to Date <br />flow, <br />Prior <br />g. Account Code <br />h. Form of Payment <br />i. In -Kind Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />Cat <br />ai <br />$ j ovo`fl <br />❑ <br />$ <br />❑ <br />$ <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />(Ztl 6 Tu— YCst t71'rr1�� ►V 1 <br />a ab G�Y15.q0 <br />Irk" O4'a N A20;0 <br />W �1.. Y <br />b. Job Title/Profession <br />d. Comments <br />c. Employer's Name/Specifie Field <br />i1u fse- ��r ,• <br />e. El"tion Sum to ttate <br />$ j t) C) <br />Prior <br />g. Account Code <br />h. Form of Payment <br />L In•Kind Description <br />j. Date (annlddlyyyy) <br />k. Amount <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 TitlelProfession <br />d. Comments <br />VY `j <br />c. Employer's Namelspecific Field <br />Election Sum to Date <br />$ P,uO' <br />Prior <br />g. Account Code <br />h. Form o-f` Payment <br />i. In•Kind Description <br />j. Date (na dddlyyyy) <br />(L Amount <br />❑ <br />i <br />1'� <br />$ � <br />❑ <br />$ <br />❑ <br />$ <br />4. Total only this Page <br />$ <br />5. Total of ALL CRO-1210 Pages <br />(This line must bean line 6 of Detailed Summary Page CRO-1100) <br />$ <br />UKO-1210 NC State Board of Elections April 2007 <br />