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Amendment <br />Disbursements Pg of �IV Yes ❑ No <br />idate! <br />Use this form to report expenditures from the committee for; operating expenses, contributions to canditical <br />committees and coordinated oarty cxuenditures. <br />1. Committee Fall Name and Fund if applicable <br />2. ID Number <br />l ee ri r 1 [yl'S e <br />3. T e of Disbursement Please uses ar CRQ-1310 forms for each twe o DisbursemeitL <br />YJ Operating Expenses ❑ Contributions to Candidates/Political Committees ❑ Coordinated Party Expenditures <br />4. Payee Information LI Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, stattstate,& xi <br />b. Coordinated Committee Name <br />d. Comments <br />�bj4u <br />iy,..! <br />c. Level Registered (Specify) <br />❑ Federal County-- <br />E] State ❑ Municipality- <br />e. Election Sum to Date <br />f. Account Code <br />g. Farm of Payment <br />h. Purpose Code <br />i, hate (mmlddlyyyy) <br />j. Amount <br />k. Required Remarks <br />451 <br />Db I,40_16 <br />+ 66- <br />4. Payee Information ❑ Add ❑ Remove <br />a. Full ]Name, Mailing Address & Phone <br />include city, state, &zip) <br />b. Coordinated Committee Name <br />d. Comments <br />h ir1 +� Na <br />a _ j <br />(p t{ �r L AljAJ <br />/�W� UJ ►JL <br />1I Copfl W t <br />c. Level Registered (Specify) <br />Federal -30 <br />El State <br />County: <br />Municipality: <br />e. Election Sum to Date <br />E Account Code <br />g. Form of Payment <br />h. Purpose Code <br />i- Date (mmiddlyyyy) <br />. Amount <br />k. Required Remarks <br />$- k <br />4. Payee Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />include city, state, &•zi <br />b. Coordinated Committee ]Name <br />d. Comments <br />ran <br />`—Y t u[�[ Y <br />r� pp� <br />c. Level Registered (Specify) <br />❑ Federal NJ county:- <br />❑ State ❑ Municipality- <br />e. Election Sum to Date <br />f. Account Code <br />g. Form of Payment <br />h. Purpose Code <br />i. Date (mmlddlyyyy) <br />j. Amount <br />k. Required Remarks <br />Page <br />5. Total only this <br />$ ' <br />6. Total of ALL CRO-IaI0 Pages <br />(This line goes in line 13a of Detailed Sammaq Page CRO-1100 if Operating Expenses) <br />(This line goes in line 13b afDetailed Sundry Page CR0-1100 if Canrrib to Ca ndidates/Political Comm) <br />(This line goes in line 13c of Detailed Summary Page CRQ1100 if Coordinated Party Expenditres) <br />$ <br />�s Q <br />7, Purpose Codes List detailed expenditure code in h. above <br />A* - Media B* - Printing C* - Fundraising 0 -'I'o Another Candidate <br />E - Salaries F* - Equipment C - Political Party H* - Holding Public Office Expenses <br />I - Postage d - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund <br />O* - Other <br />* Codes require detailed explanation in required remarks field k <br />CRO-1310 NC State board of Elections December 2009 <br />