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Contributions from Individuals <br />Pg 2 of <br />Amendment <br />® Yes ❑ No <br />Use this form to report individual contributions over $50 or contributions under $50 if form CRC 1205 is not used <br />I. Committee Full Name and Fund if applicable) <br />2. ID Number <br />COMMITTEE 'I'0 ELECT INGRID NURSE <br />IN2024 <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phonc <br />(include city, state, & sip) <br />b. Job Title/Profession <br />d. Comments <br />RETIRED <br />CHECK 93279 <br />MAYOLA THOMAS <br />2913 N ROGERS AVE <br />GWYNN OAK, MD 21297 <br />c. Employer's Name/Specific Field <br />NURSE <br />c. Election Sum to Date <br />100 <br />E Prior <br />g. Account Code <br />h. Form of Payment <br />L In -Kind Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Dull Name, '*Iailing Address & Phone <br />(include city, state, & sip) <br />b. Job Title/Profession <br />d. Comments <br />RETIRED <br />CHECK 9 372 <br />MARY WILLIAMS <br />STREET659 CENTRAL DR NW <br />CONCORD, NC 28027 <br />c. Employer's Name/Specific Field <br />CNA <br />e. Election Sum to Date <br />$ 50 <br />E Prior <br />g. Account Code <br />h. Form of Payment <br />i. IG-Find Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />$ <br />❑ <br />$ <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & sip) <br />b. Job Title/Profession <br />d. Comments <br />AUTO DEALER <br />ACR BLUE <br />01/12/2026 <br />CYTHIA MYNATT <br />200 WASHINGTON LANE SE <br />CONCORD, NC 28025 <br />c. Employer's Name/Specific Field <br />BEN MYNATT <br />e. Election Sum to Date <br />$ 100 <br />f. Prior <br />g. Account Code <br />h. Form of Payment <br />L In -Kind Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />$ <br />❑ <br />$ <br />4. Total <br />only this Page S <br />otal of ALL CRO-1214 Pages is line must be on line 6 of Detailed Summary Page CRD-1100) <br />L(nT <br />CRO-1210 NC State 13oard of Elections April 2007 <br />