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Amendment <br />Disbursements PC of RI Ycs ❑ No <br />Use this form to report expenditures from the committee for; operating; expenses, contributions to Anidate/political <br />committees and coordinated vartv expenditures. <br />1. Committee Full Name and Fund if a iicable <br />2. ID Numbcr <br />3. Type of Disbursement Please use separate CRO-131U formu for each type of Disbursement <br />[Operating F.xpcn�,,:s ❑ Contributions to Candidal eshloIiticaI Committees ❑ Coordinated Party Expenditures <br />4. Payee Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />include city, state, & xi <br />b. Coordinated Committee Name <br />d. Comments <br />1 <br />����y �( j' �� �1 W <br />a3oa-- <br />c. Level Registered (Specify) <br />❑ Federal County: <br />❑ state Pf Municipality: <br />e. Election Sum to Date <br />$ <br />f. Account Code <br />g. Farm of Payment <br />h. Purpose Code <br />t. Date (mmlddlyyyy) <br />j. Amount <br />k. Required Remarks <br />� <br />. <br />C <br />061 0 <br />$ �s <br />4. Payee Information ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />include city, state, & xi <br />b. Coordinated Committee Name <br />d. Comments <br />II N ly lZ I b MA R513 <br />r r _7 <br />3 q D 1 pf I i� 1I]� $+ N L� <br />go <br />c. Level Rgis <br />ettred (Specify) <br />❑ Federal County: <br />❑ State Municipality: <br />e. Election Sum to Date <br />f. Account Code <br />g. Form or Payment <br />h. Purpose Code <br />i. Date (mmlddlyyyy) <br />j. Amount <br />k. Required Remarks <br />e, <br />CIA- <br />4. Nee Inforrttation ❑ Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />include city, state, & xi <br />h. Coordinated Committee Name <br />d. Comments <br />14� t I ii r �y ,V I` <br />�', , ��r'l-y <br />C.Gtti� gD� <br />c. Level Registered (Specify) <br />❑ federal County: <br />❑ State ❑ Municipality: <br />c. Election Sum to Date <br />$ <br />r. Account Code <br />g. Form of Payment <br />h. Purpose Code <br />i. Date (mmlddlyyyy) <br />j. Amount <br />k. Required Remarks <br />G <br />ter+ <br />06/;)-1 <br />$.s�a3 <br />Page 5 <br />5. Total only this <br />6. Total of ALL CRO-1314 Pages <br />(This line goes in line 13a of Detailed Summary Page CRO-1100 if Operadng Expenses) S � <br />(This line goes in fine 13h of Detailed Summary Page CROc11#0 if Contrib to Candidales/Pofflical Comm) J750. <br />(Then line goes in line 13c of Detailed Summary Page CRO-1100 if Coordinated Party Expenditures) <br />7. Purpose Codes List detailed expenditure code in h. above <br />A* - Media B* - Printing C* - Fundraising D - To Another Candidate <br />E - Salaries F* - Equipment G - Political Party H* - Holding Public Office Expenses <br />1 - Postage .1 - Penalties K* - Office Expenses Q* - Donation to Legal Expense Fund <br />O* - Other <br />*Codes require detailed ex lanation in required remarks held k <br />CRO-1310 NC state Board of Hections December 2009 <br />