Laserfiche WebLink
Contributions from Individuals <br />Amendment <br />Pg Il of 11 ❑ Yes ® No <br />Use this form 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 />BAILEY FOR CABARRUS <br />CAB-R$1N22-C-001 <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Nlailing Address & Phone <br />b. Job Titie/Profession <br />d. Comments <br />(in el a de 6 tF, state, & xi p) <br />.._. <br />CORDINATOR <br />..................... <br />...... .............. -- <br />KEITH WENSIL <br />e. Flnplimer's NantelSpeciiic Field <br />7152 MT PLEASANTRD S <br />CONCORD, NC 28025 <br />RCCC <br />c. Election Sum to Date <br />$ <br />200.00 <br />r. Prit)r <br />g. Account ('ode <br />lt. Form orPayment <br />i. In -Kind Description <br />j. date (mmlddlyyyy) <br />k. Amount <br />❑ <br />p <br />Credit Card <br />011151202E <br />$ <br />200.00 <br />4. Total only this Page <br />$ <br />200.00 <br />5. Total of ALL CRO-1 Z 10 Pages <br />(This line maw be on line b ofDeiailed Summary Page CRO-1100) <br />$ <br />8,400.00 <br />CRO-1210 v( State Board of [Jertions April2007 <br />