Laserfiche WebLink
Contributions from Individuals <br />Amendment <br />Pg 3 of 5 ©I es ❑❑ <br />Use this form to report indi-,idual contributions over S50 of contributions under S50 if fonn CRO 12G5 is not used <br />... Cetmmiitee Fell Name and Fund if ................................... .... ................... <br />2. iO-Nnai er.......................... <br />COMMITTEE TO ELECT ROBERT KIRK <br />3. Connibe[vr bdbrmzd= ❑ .add ❑ Remove <br />a. Full Name, 3fsiling Address & Phone <br />b. Jab TitlePenfessicn ............................................................................................... <br />d. Camm*nts <br />(include City, stater & Zip) <br />.............................................................................................-..............-................ .. -..... <br />. •......•••.............. ......• <br />RETIRED <br />.FAMES ROBERT KIRK <br />e, Employer's Nawel$pecifie Field <br />... .......... ..............-............................. ... ............................ <br />1193 MANOR OAK PLACE NW <br />CONCORD, NC 28027 <br />NOT EMPLOYED <br />e. Elettioo Sum to Bate <br />5 3,667.73 <br />f. prior <br />........................................................................................... <br />X. i,ecaunt Code <br />h, Form of Payment <br />i. in-ldind. Dezeription <br />----...--•—------ ----- ---•------- --•-------- <br />j. Date (mm.,ddlyyy�y) <br />----•-••------........-----........�..._.........-.....-................................... <br />Ir !mount.............. .......... <br />❑ <br />pl <br />Debit Card <br />41/10.i2026 <br />S 10.59 <br />❑ <br />Ell <br />In -Kind <br />Nanic ]3adee <br />01AW2026 <br />j 38.52 <br />❑ <br />01 <br />rn-KiTjd <br />1,6111'\luiia <br />01/19/2026 <br />r 81.22 <br />3. ContributaF Information. ❑ Add ❑ Remo,,,-e <br />a. Pull ",4ame, 3laiiing Address & Phone <br />b. Job Title.Prnfession <br />d Comments <br />(include city, state, �& zip) <br />............................................................................................................................................. <br />................................................................................................................................................................ <br />RETIRED <br />3AMES ROBERT KIRK <br />c, Employ er'x NamelSpeeffie Field <br />.................................... . <br />1193 MANOR OAK PLACE NW <br />CONCORD, NC 29027 <br />NOT EMPLOYED <br />e. Election Sum to Bate <br />5 3.667,73 <br />f Prior <br />g ?lccount Code <br />---------------------- ---- - - -- <br />h. Form of 3Paymeat <br />---- ••......_...................._...�._......... <br />i. In-iiad Deaeripdoa <br />---...�......._....-_.-...-.... _............... _...............� <br />j. Date (rpm dd �..y} <br />........ ...................................... .................................... <br />k. ?lmouat <br />..................... ........... <br />❑ <br />01 <br />In -Kind <br />Business cards <br />O 1119J2026 <br />5 101.65 <br />❑ <br />(11 <br />In -Kind <br />Yard signs <br />01/19/2026 <br />5 3,236.75 <br />13 <br />3. Coutributot� Infomation ❑ Add ❑ Remove <br />a. Fu11 Name. MailinI- address k Phone <br />b. Job Title:Pmfessioo <br />d. Comments <br />(include citT, state, & zip) <br />............................................................................................ _ .............................. <br />------------------------- <br />Owner <br />DAN LEVINSON <br />E. Employer's _ ame!Specifiic Field. <br />. .......................................................................................... . <br />5814 Stimmerston Place <br />CHARLOTTE, NC 28027 <br />Ellis Jewelers <br />e, Election Sum to Date <br />S 500.00 <br />f Prior <br />g. Account Cade <br />h. Form of Payment <br />_......._......---•-- ---- - <br />i. is -Bind Deseription <br />j. Date (a�a dd�y ►�} <br />h AmountW............_.- <br />nl <br />Check <br />S 500.00 <br />❑ <br />5 <br />❑ <br />5 <br />4. Total otuh- this Paige 3,968.73 <br />5. Total of :ALL CRO-1210 Pages <br />5 7,377.40 <br />(lhir fine mnsr be on fine 6 ojDow rd 5usexian' Pa#e CEO-1100) <br />