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amendment <br />RefuudsfRehubursements From the Committee Pg ' of ® vea ❑ tie <br />Use this form to revort refunds reimbursements_ includine contributions retumed to the contributor <br />i. Comer Fell Name-{andE Fed if appheaue <br />3. IDNumber <br />COMMITTEE TO ELECT ROBERT KIRK <br />. Payee Information © A-dd ❑ Remove <br />a. Full °dame, Mailing Address $ Phone <br />d. T}pe of Cotmittee <br />g C'ommeuta <br />(include city, state. &- zip} <br />Q Cati�tr�[e <br />s .. <br />ECK ANi7 DUPLICATE ONLINE <br />.........................................--........ • •• .... •....,.....--....--.................-..-.,........._........».»............... <br />DUSTrN KEITH <br />❑ Referexdrrn <br />❑Part+ <br />AYMEhnsERROR <br />e, Lerel Registered (Specify) <br />h. Original Receipt Date <br />5930 MORAY COURT NW <br />CONCORD, NC 28027 <br />....................._. <br />❑ F'°'z2t <br />.................. <br />Q Counts: <br />....... .......................................... .... ...................... <br />01/28/2026 <br />❑ Slag <br />❑ 3I:micipai+Iy: <br />........... _......... -.__. <br />............ - ........... - ...... -....... <br />i. Origins, Receipt Amount <br />..._._. _...........�...... .......................... <br />5 1,000.00 <br />U. Job TitleProfessiou <br />...................--......--..— ---- --------- - <br />c. Emp1oy*ea'Name Specific Fier <br />----- - - _. W. .. W_._ <br />L Purpose Code <br />........_.............._...... <br />_._.._. _. __ .. <br />j. Election Sum to Date <br />........_................._ m_.... <br />OWNER <br />AQUAVENTURE WATERCRAFT <br />0 <br />� 529.60 <br />RENTALS <br />k. Armunt Code <br />............... �..... ... _. . m.... . <br />L Form of Payment <br />m. Required Remat-x <br />A. Date (aamiddi -} <br />o. Amount <br />01 <br />Check <br />REFUNDOFCONTRIBrMON <br />02/11/2026 <br />S 1.000.00 <br />4. Total only this Page <br />1,000-00 <br />5. Total of ALL C:RO-1320 Pages <br />5 <br />(This line masr bye on Fare 13 of Derailed Sunewaii- Page CRO-I100) <br />1,a0d.Q0 <br />6. Purpose Caries (List detailed disbursement code in (f above) <br />L - Returned to Contributor 1: - D--erpaiment for Senlice <br />N - i-%ceeded Contibution Limit <br />P* - Reimbursement of lu-lain O* Other <br />* Codes re uire details explanation in rewarim field m <br />CRO-1320 -NC statx ji=d c: h1- cste-ra JUN aVT <br />