HomeMy WebLinkAbout10: M12-17 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
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[9""Check here if address has changed
(4) Check appropriate box(es):
!;?'candidate Office Sought:
D Political Committee (PC)
D Electioneering Communications Org. (ECO)
D Party Executive Committee (PTY)
D Independent Expenditure (IE) (also covers an
individual making electioneering communications)
OFFICE USE ONLY
(3) ID Number: -----------------
D Check here if PC or ECO has disbanded
D Check here if PTY has disbanded
D Check here if no other IE or EC reports will be filed
(5) Report Identifiers
Cover Period: From /2 I 0/ I .2017 To /2 I ~I oZ1J17 Report Type: M12 -1'7
[9'6riginal 0Amendment D Special Election Report
(6) Contributions This Report
Cash & Checks $_ ' -' 6tJIJ . .1M_
Loans $ ' ' --------
Total Monetary $
In-Kind $ ' ' --------
(9) TOTAL Monetary Contributions To Date
$ -' -' /Jf() . _£}__
(7) Expenditures This Report
Monetary
Expenditures
Transfers to
Office Account
Total Monetary
$
$
$
' -------
' ' ------
(8) Other Distributions
$ --·--·--
(10) TOTAL Monetary Expenditures To Date
$ ~ ' - ' 15.)-. _!)_
( 11) Certification
It 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)
0 Individual (only for IE D Treasurer D Deputy Treasurer
or electioneering comm.)
Signature cJ
OS-DE 12 (Rev. 11/13)
(Type name)
D Candidate D Chairperson (only for PC and PTY)
SEE REVERSE FOR INSTRUCTIONS
-
CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
(1) Name f 1 /t/1> ;4 f/ /1-o L '-D t-01(' (2) 1.0. Number
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(5) (7) (8) (9)
Date Full Name
(6) (Last, Suffix, First, Middle)
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Number Citv, State, Zip Code Type Occupation Type
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(10)
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Description
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Amendment Amount
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OS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES