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Amendment <br />In -Kind Contributions Pg of ❑ Yes ❑ No <br />Use this form to report non -monetary contributions, donations, goods or services provided to the committee or fund. <br />i Ise CRC]-1215 if In -Kind Contributions were or will be refunded within 7 days. <br />1. Committee Full Name (and Fund if applicable) _ <br />2. ID Number <br />. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Type of Contributor <br />111-I1,dividual <br />❑ Candidate <br />❑ Party <br />c. Comments <br />,5--! S C,/ ,i,r p- w � p/] -" � C� <br />,�1J �, t <br />❑ PAC <br />t <br />❑ Referendum <br />d. Election Sum to Date <br />! <br />❑ Other Receipt Source <br />$ <br />e. Description <br />f. Date (mmlddlyyyy) <br />13 <br />g. Fair Market Amount <br />39P ,70 <br />$ <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Type of Contributor <br />❑ Individual <br />❑ Candidate <br />c. Comments <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />❑ Other Receipt Source <br />d. Election Sum to Date <br />$ <br />e. Description <br />f. Date (mmdddlyyyy) <br />g. Fair Market Amount <br />$ <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Type of Contributor <br />❑ Individual <br />❑ Candidate <br />❑ Party <br />C. Comments <br />❑ PAC <br />❑ Referendum <br />❑ Other Receipt Source <br />d EleMion Sum to Date <br />$ <br />e. Description <br />L Date (mmlddlyyyy) <br />g. Fair Market Amount <br />4. Total only this PageG'�, <br />5. Total of ALL CRO-1514 Pages <br />(This line must be online 17 of Detailed Summary Page CRO-1100) <br />CRO- f 5 JQ NC State Board of Elections December 2007 <br />