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Amendment <br />Contributions from Individuals Pg I of I ® Yes ❑ No <br />Use this form to report individual contributions over $50 or contributions tinder $50 if form CRO 1205 is not used <br />11. Committee Full Name and Fund if applicable) <br />2. 11) Number <br />COMMIT" I'EE TO ELECT INGRID NURSE <br />1N 2024 <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Job Title/Profession <br />d. Comments <br />RETIRED <br />GRACE GALLOWAY <br />Y J <br />CVYIGL�C� I( �j <br />c. Employer's Name/Specific Field <br />NURSE PRACTITIONER <br />SELF EMPLOYED <br />e. Election Sum to Date <br />f. Prior <br />g. Account Code <br />h. Form of Payment <br />i. In -Kind Description <br />j- Date (mmlddlyyyy) <br />k_ Amount <br />❑ <br />G <br />CHECK <br />12-16-2025 <br />$ 250 <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 />c. Employer's Name/Specific Field <br />e. Election Sum to Date <br />S <br />f. Prior <br />g. Account Code <br />h. Form of Payment <br />i. In -Kind Description <br />j. Date (mmlddl M) <br />k. Amount <br />❑ <br />$ <br />❑ <br />$ <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, &•rip) <br />b. Job TltlelProfession <br />d. Comments <br />c. Employer's Name/Specific Field <br />c. Election Sum to Date <br />$ <br />f. Prior <br />g. Account Code <br />h. Form of Payment <br />i. In -Kind Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />$ <br />4. Total <br />only this Page $ 250 <br />5. Total of ALL CRO-1210 Pages <br />$ 250 <br />(This line wrest be online b of Detailed Summary Page CRO-1100) <br />CRO-1210 N(' State Board of Elections April 2007 <br />