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Amendment <br />Contributions from Individuals <br />Pg 2 of <br />❑ Yes ® No <br />Use this form to report individual contributions over $54 or contributions tinder $50 if form CRO 1205 is not used <br />1. Committee Full Name and Fund if applicable) <br />2. ID Number <br />COMNUTTEE TO ELECT PAM ESCOBAR <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Job TtticlProfession <br />d. Comments <br />TOBACCO TREATMENT <br />SPECIALIST <br />DORSEY WARD <br />572 DOGWOOD ST SE <br />CONCORD, NC 28025 <br />c. Employer's Name/Specific Field <br />TABAKNIX, LLC <br />e. Election Sum to Date <br />$ 500.00 <br />L Prior <br />g. Account Code <br />h. Form of Paymcnt <br />i, in -Kind Description <br />j. Date (mmlddlyyyy) <br />k. amount <br />Ll <br />2 <br />Electric Funds Tran <br />45/1312426 <br />$ 500.00 <br />❑ <br />$ <br />3. Contributor Information ❑ Add ❑ Remo c <br />a. Full Name, hlailingAddress & Phone <br />(include city, state, & zip) <br />b. Job 11 tie Xrofession <br />d. Comments <br />PROFESSOR <br />WENDY WOOD <br />717 UNION ST S <br />CONCORD, NC 28025 <br />c. Employer's Name/Specific Field <br />UNC CHARLOTTE <br />e. Election Sum to Date <br />103.48 <br />f. Prior <br />g. Account Code <br />h. Form of Payment <br />i. In -Kind Description <br />j. Date (mmlddlyyyy) <br />k.:lmnunt <br />$ 103.48 <br />2 <br />Electric Funds Tran <br />05/24/2026 <br />❑ <br />$ <br />❑ <br />$ <br />4. Total only this Page <br />$ 603.48 <br />5. Total of ALL CRO-1210 Pages <br />(Tkis line meat be on Tine 6 of Detailed Summary Page CRO-1100) <br />$ 8 $ 5 47 <br />C'RU-1210 M. tit ate hoard of i lections April 2001 <br />