HomeMy WebLinkAbout02: M04-17 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
(1) LihTM f^cmr^es, /-hi
N
OFFICE USE ONLY
ame
(2) xi>4sr
Address (number and street)
Miami I^L 35 9
Ctty oJ Mjamj Gardens
Received iiiJhe
City. State, Zip Code
Time; 3 C^T
By. .X
Q Check here if address has changed (3) ID Number:
(4)Check appropriate box(es):
0^Candidate Office Sought: ^0 OMC! IaJ ^
□ Political Committee (PC)
□ Electioneering Communications Org. (ECO) □ Check here if PC or ECO has disbanded
□ Party Executive Committee (PTY) □ Check here if PTY has disbanded
□ Independent Expenditure (IE) (also covers an □ Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From Ql^ i {)/ i To Z'/ Report Type:
□ Original □ Amendment □ Special Election Report 7d
(6) Contributions This Report
Cash & Checks $
Loans $
Total Monetary $
In-Kind
(7) Expenditures This Report
Monetary
Expenditures $ , ,
Transfers to
Office Account $ ,
Total Monetary $
(8) Other Distributions
$I I
(9) TOTAL Monetary Contributions To Date
$ —, —
(10) TOTAL Monetary Expenditures To Date
$ . . .
(11) CertificationIt is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
I certify that I have examined this report and it is true, correct, and complete:
(Type name) L f'^L 11 Lj/fy/
B Treasurer □ Deputy Treasurer□ Individual (only for IE
(Type name)
a Candidateor electioneering comm.)□ Chairperson (only for PC and PTY)
X
Signature Signature
DS-OE 12 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
TO
(1) Name L Pt>LL.Oo^A/(2) I.D. Number
(3) Cover Period / 0/ / through ()cl / 30 / SAZT (4) PaQe / of f
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
(8)
Contributor
(9)
Contribution
(10)
In-kind
(11)(12)
(6)
Sequence
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE13 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES