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Contributions from Individuals <br />Amendment <br />Pg 3 of 3 ® Yes ❑ No <br />Ilse this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used <br />1. Committee Full Name and Fund if applicable) <br />2. ID Number <br />COMMITTEE TO ELECT INGRID NURSE <br />1N2024 <br />3. Contributor information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Job TitlelPrefession <br />d. Comments <br />RETIRED <br />CHECK #2535 <br />ANDY LANGFORD <br />801 ROTHMOORE DR N <br />CONCORD, NC 28015 <br />c. Employer's NamVSpeciTic Field <br />MINISTER <br />e. Election Sum to Date <br />$ 100 <br />L 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 />❑ <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. Cocnmenis <br />c. Employer's Name/Specific Field <br />e. Election Sum to Date <br />f. Prior <br />g. Account Code <br />h. Form of Pavraeut <br />G In -Kind Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />$ <br />❑ <br />S <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Job'iitlelProfession <br />d. Comments <br />c. Employer's Name/Speeifit Field <br />c. Hection 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 />❑ <br />$ <br />4. Total only this Page 100 <br />otal of ALL CRO-1210 Pages $ $900 <br />Lf-& linemustheon lineti of DetailedSummary Page CRD-1l00) <br />CRO-1210 NC State Board of Elections April 2007 <br />