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Contributions from Individuals <br />Amendment <br />pg I of 14 ® Tea ❑ '-%,o <br />I. se tins form to report indi-ndual contributions over S50 or contributions under Sj0 if form CRO 120i is not used <br />1. CeunwIttee Fall Name and Fund if <br />•---------------------------------------• • .........-.._... m.._._.-._...1 <br />2. ID Ntmtber <br />COMMITTEE TO ELECT KRISTEL SWAYZE <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full tinme, ]failing Address & Phone <br />b. Job Tide: Profession <br />--------------- I.. ............... ............-...............................-........................m._m...........-.......... <br />d. Comments <br />(include city, state, & sip) <br />_--- _------------------------ .... ---- __ ...� .m ..._. _ ._......... ........ <br />RETIRED <br />KIRBY SI IERIDAN <br />C. Employer's Name+Specific Field <br />-------------_-.m-_....—.-._ _........................... <br />5924 BECKETTE CT NW 1 <br />CONCORD, NC 28027 <br />RI -A -IRE D <br />e. Election Sum to Date <br />.................................................................... <br />200.00 <br />£ Prior <br />........ ....... ....................................... <br />F. Account Code <br />.......................... <br />b. Form of Payment i. In -Kind Description <br />.......... .................... ............ .................... ....................... ............. ............................................. <br />j. Date (utm4d.�1yy) <br />........1.................-...--------................................................ <br />Is. Amount .. <br />❑ <br />123456 <br />Credit Card <br />01/17/2026 <br />S 200.00 <br />❑ <br />5 <br />❑ <br />S <br />3. Contributor hdoramation ❑ Add ❑ Remove <br />3, Fall Name, %failing Address & Phone <br />b. Job ride�'Profession <br />......................................................................... <br />d. Comments <br />W....................... ...... <br />(include city, state, & zip) <br />- --- — - -- - ----------------------------------------------------------------------------------------------------- <br />PHARMACIS'r <br />TAMMY SMITH <br />c. Employer's NameJSpecific Field <br />..................................................................................... <br />5182 BUTTERNUT DRIVE <br />CHARLOT'TE,NC 28215 <br />VA <br />e. Election Smut to Date <br />------- - - ----------------------------_..................... <br />S 100.00 <br />£ Prior <br />........ <br />g. Accaunt Code <br />............ <br />h. Farm of Payment <br />..............--...................-. <br />i In --Bind Description <br />-.-.-..-..................................................... .......... .................... <br />j. Date (mmlddY)yyy) <br />-......_.............. ...... <br />k. Amount <br />123456 <br />Credit Card <br />01/23/2026 <br />S 100.00 <br />❑ <br />5 <br />❑ <br />S <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, ][ailing Address & Phone <br />b. Job TidePmfesaion <br />d. Comments <br />(include city, state, & zip] ........-._....-.... <br />... .............. .......................... ............................................................... -._...... <br />..--................................................................................... <br />RETIRED <br />------ ---------------- -------------------------..- <br />KENNETH SWAYZE <br />c. Employer'&NamelSpecific Field <br />.................... ------------------------- <br />4300 DEACON COURT <br />CONCORD, NC 28025 <br />RETIRED <br />e. Election Sum to Date <br />......................... <br />5 250.00 <br />E Prior <br />............................................................................................................................................................................................ <br />g. Account Code <br />h. Form of payment <br />i. In -Kind Description <br />j. Date (mmldd.yyyy) <br />_.. _ - W.................................................................. <br />k..Amonnt <br />13 <br />123456 <br />Check <br />01/12/2026 <br />5 25&00 <br />❑ <br />S <br />❑ <br />5 <br />4. Total o>al► this Page g 550.00 <br />5. Total of :ALL C-RO-1210 Pages <br />(This dine ututr be on hij r 6 ojllrrsi1*d Suxwaaq PAje CRO-1104 S 12,334.45 <br />C'RO-1210 tiC State Board of Electow Apni luo <br />