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Contributions from Individuals <br />Amendment <br />Pe 2 of 5 V3 yet ❑ No <br />[: se this fotvi to report indi-, idual contributions over 550 or contributions under 55t if fonn CR01205 is not used <br />I. Committee FxU -Name Fnad if aplSEica lei -- ... <br />........................... .... .........._...... ....... . • ............-.--..,........ <br />?. ID Number <br />••- ...... • • ...................... <br />COMMITTEE TO ELECT ROBERT KIRK <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Fall -Name. �lei ilioe .'Address & Phhone <br />- <br />b. Job TitleiPtolession <br />d' Comments <br />(include city, state, & rip) <br />... -............. •-.--.-......... ........•.................................................................................. <br />................................................................................... <br />NO JOB TITLE <br />.... ........... --- -------------------- <br />CYNTHIA FERTENBAUGH <br />c. Employer's -Name.,Sgerifie Field <br />...-..................................................................................... <br />5620 VILLAGE DR NW <br />CONCORD, NG 28025 <br />NOT EMPLOYED <br />e. Ileetion Sttm to Date <br />.................................................................... <br />200.00 <br />f. Prior <br />g. Account Code <br />.... <br />h. Form of Payment <br />....................................... -_............................._ <br />i. la -Kind Description <br />............... .�...................... ..............._ <br />i. Date �ww dd yy yi <br />..._..-..-..--....-......-....-----------'--------- <br />L. Amount <br />....--......................................._.�.... <br />© <br />01 <br />Chmk <br />01/22/2026 <br />5 200.00 <br />© <br />5 <br />❑ <br />5 <br />3. Contributor Information ❑ Add ❑ Re none <br />a. Full Nance, Mailiur Address & Phone <br />b. Job Title Profession <br />d. Comments <br />(include city, state, & sip) <br />................................_...................................................................._..................................................... <br />................................................................................................................. <br />OWNER <br />DUSTIN KEITH <br />c. Emglo} er'a tiatueiSpeeifie Field <br />............................................................................................. <br />5930 MORAY COURT NW <br />CONCORD, NC 28027 <br />AQUAVENTURE <br />E. ilectioa Sum to Date <br />.................................................................... <br />WATERCRAFT RENTALS <br />S 529.60 <br />E Prior <br />g. Account Code <br />h. Form of Payment <br />L In4Uzd Description <br />] Date (tu n-A&M-r) <br />h Amount <br />0 <br />Chet <br />01/28/2026 <br />S 500.00 <br />❑ <br />01 <br />CFudit Card <br />02/04/2026 <br />5 514.90 <br />❑ <br />,,, <br />credit card <br />02/04/2026 <br />514-80 <br />3. Contributor Informariott O Add ❑ Remove <br />a. Full 1 awe. Ma ilin a Addres : @ Ph on a <br />- <br />b. Job Titl4e Pmfesaiov <br />d. Comments <br />(include city. state..0 Lip) <br />...................................................................................................... <br />.................................................................................................................. <br />PHYSICIANS ASSISTANT <br />DANIEL KIRK <br />e. Employer's Nzme Specific Field <br />......... .......................... <br />6209 BRYAN PKWY <br />DALLAS, TX 75214 <br />US SOUTHWESTERN <br />e. Election Sum to Date <br />-------------------------------------------------------------------- <br />HOSPITAL <br />5 245-87 <br />E Prior <br />ram. Account Code <br />h. Farm of Payment <br />.. ........................_................................_............-.-.....-........_....................................._.....W...W. <br />L In -band Deseriptitm <br />j. Date (mm7d iiy�) <br />�.._.._......... _......... <br />h. Amount <br />......-................_W..W.................... <br />❑ <br />01 <br />Cmdk Card <br />01/18/2026 <br />5 245.97 <br />❑ <br />5 <br />❑ <br />S <br />4. Total outs' this Pane 5 1,975.47 <br />5. Tool of ALL CRC)-1210 Pages 5 7,377.40 <br />1Ihis hne miju be oN Ime 6 of Pei.. tied Stt•ta,c:, Page CRO-1140 <br />CR0-1210 NC State Board a: Electena kP-11 XC. <br />