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Amendment <br />In -Kind Contributions Pg of ( 0 Yes ❑ No <br />Use this fonn to report non -monetary contributions, donations, goods or services provided to the committee or fund. <br />Use CRO-1215 if In -Kind Contributions were or will be refunded within 7 days. <br />1. Committee Full Name (and Fund if applicable) <br />2. ID Number <br />3. Contributor Information ❑ Add Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & rip) <br />b. Type of Contributor <br />c. Comments <br />Individual <br />❑ Candidate <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />❑ Other Receipt Source <br />d. Election Sum to Date <br />$ <br />c. Description <br />£ Date (mmlddlyyyy) <br />g. Fair Market Amount <br />3. Contributor Information El Add ❑ Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Type of Contributor <br />c_ Comments <br />❑ Individual <br />❑ Candidate <br />❑ Patty <br />❑ PAC <br />❑ Referendum <br />❑ Other Receipt Source <br />d. Election Sum to Date <br />$ <br />e. Description <br />£ Date (m yyyy) <br />g. Fair Market Amount <br />$ <br />3. Contributor Information ❑ Add Remove <br />a. Full Name, Mailing Address & Phone <br />(include city, state, & zip) <br />b. Type of Contributor <br />c. Comments <br />❑ Individual <br />❑ Candidate <br />❑ Party <br />❑ PAC <br />❑ Referendum <br />❑ Other Receipt Source <br />d. Election Sum to Date <br />$ <br />e. Description <br />E Date (mmlddlyyyy) <br />g. Fair Market Amount <br />$ <br />4. Total only this Page $ <br />5. Total of ALL CRO-1510 Pages $ <br />(This line must 6e on line 17 of Detailed Summary Page CRO-I100) <br />CRO-1510 NC State Board of Elections December 2007 <br />