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Amendment <br />Conh iburions from Individuals <br />Pr' 2 of 14 <br />® Tea ❑ No <br />Use this form to revorr individual contributions over 550 or contributions under S50 if form CRO 1205 is not used <br />L Quitter Fell Name [ Fzs ii..............................................................,-ID <br />Nader:..-.-. .......... ....-...:_ <br />COMMITTEE TO ELECT KRISTEL S WAYZE <br />3. Contributor information ❑ Add ❑ Remove <br />a. Full Name, Nfailing Address & Phone <br />h. doh Title.Profession <br />----------- --------------------------- ..................... .............. I ---- -- <br />d. Comments <br />---------------------------•...... ...... .._._..................... <br />(include city, state, St zap) <br />... ................ <br />PUBLIC RELATIONS <br />KAREN COBB <br />C. Employers Name."SperificField <br />... .............................. <br />4119 IRISH WOODS DRIVE <br />CONCORD, NC 28025 <br />RETiRF.D <br />e. Election Sum to Date <br />S 100.00 <br />L Prior <br />g. Account Code <br />........................................... .. <br />h. Form of Payment <br />......... ....................I....................... <br />i. In -Kind Description <br />...... ......................................................................... <br />1. Date (mmidd+}27,g) . <br />lz Amount <br />............ ..................------_-------------------- <br />❑ <br />123456 <br />Chcck <br />0112V2026 <br />S 100.00 <br />❑ <br />S <br />❑ <br />S <br />3. Contr"tor Information ❑?Add ❑ Remove <br />a. FuH - ame, Mailing Addreaz & Phone <br />h. Joh TideLProfession <br />-...........".......................................................-.......-....._........ <br />d. Comments-............. _... <br />(include city, state, St zip) <br />........................ ...._. <br />RETIRED <br />VICTOR CONRAD <br />c. Employe sName+Spedfic Field <br />5503 PEACHGROVE COURT <br />HARRISBURG, NC 28075 <br />RETIRED <br />e. Election Sum to Date <br />S 100.00 <br />EPrior <br />& Acco. <br />......................................................... <br />..----------------•-------.........................................................m.. <br />-..--._....................................... <br />- ---------- ---......... <br />❑ <br />123456 <br />Check <br />02/04/2026 <br />S 100.00 <br />❑ <br />] <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Fall Name, Mailing 'Lddresa & Phone <br />U. soh Title -Profession <br />.............................. I... ------- --- <br />Comments <br />.... <br />(inelude city, state, & zip) <br />-..............................................................................._.........._-.W.....-------- <br />OFFICE ADMINISTRA PION <br />ERICA COUNCIL <br />c. Employer'sNam"peei$a Field <br />m............................................................. <br />3223 CHATFIELD LANE SW <br />CONCORD, NC 28027 <br />CORA PHYSICAL THERAPY <br />e. Election Sum to hate <br />S 100.00 <br />f, Prim <br />..... ...... <br />g. Account Code <br />................................................................................................._- <br />h. Form of Payment <br />i. In -Bind Description <br />.-....--............................................... • <br />1. Date (mm7diLl" ry) <br />....-------- ------------ --........_....................... <br />Is Amount <br />......... ....------------- .......................... <br />❑ <br />123456 <br />Credit Card <br />01 /22/2026 <br />S 100.00 <br />❑ <br />S <br />❑ <br />S <br />4. Total ooh this Page S 300.00 <br />+. TOW of ALL CRO-1210 Pages <br />$ 12.334.45 <br />(ntk hw ttmw hoe on hw 6 of Derar7@d Sauun wry Page CRU-1104) <br />C3?0-I210 -NC State Saud of tiectson- aPrtt zm- <br />