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Contributions from individuals Amendment <br />Pg �� of �0 Yes ❑ No <br />Use this form to report individual contributions over $50 or contributions under SSO if form CRC] 1205 is not aced <br />I. Committee Full Name and Fund if applicable <br />2. ID Number <br />eOMMl }} e_ e_ 40 Vd&Lt1 [Ltf <br />I <br />3. Contributor Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />h. Job Title/Profession <br />d. Comments <br />Ctl.3 &atjAOrAo[n <br />S2$firle la . � r Xv r <br />k0 oil aG�►,/i !I-� 2� <br />c. Employer's Name/Specific Field <br />�itnn�Pa[fs �� <br />C..oxsn C4' 1 <br />e. Election Sum to Date <br />� <br />f. Prior <br />g. Account Code <br />h. Form of Payment <br />i. In -Kind Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />Ira <br />3. Contributor <br />Information Add ❑ Remove <br />a_ Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Job TitlelProfessioit <br />d. Comments <br />';�Oh.e �.�, j <br />Crag- 6�t 110ti 0-� <br />D-1 —+ PaAa .5,-� r 1d� <br />c_ Employer's Nam OSpecific Field <br />e. Election Sum to Date <br />G Prior <br />g. Account Code <br />h. Form of Payment <br />i. In -Kind Description <br />j. Date (mmlddlyyyy) <br />k- Amount <br />�7 <br />T <br />— <br />$ <br />❑ <br />$ <br />3. Contributor <br />Inforrnatii)n ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Job Title/Profession <br />d. Comments <br />c_ Employer's NamelSpecific Field <br />E. F:Iect➢on Sum to Date <br />C Prior <br />g. Account Code <br />h. Form of Payment <br />i. In -Kind Description <br />j. Date (mmlddlyyyy) <br />k. Amount <br />❑ <br />$ <br />4. Total only this Page $ .,DID <br />5. Total of ALL CRrd-12i0 Pages <br />(This lixe must be an lure b of Detailed Suarmory Page CRC-1100) $ <br />N <br />GRu-111 f1 NC State Board of Elections April 2007 <br />