HomeMy WebLinkAbout10: M12-17 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
(1)Sr^aq Eh*nr- MDr*r.l/
(2t j6i.+" Nv1 efrs+?6ce.
Address (nump
l'Y'\ r
er nd fl- zeo ss
City, State, Zip Code
fJ Cnect h€re if address has changed (3) lO Number
(4)Ch€ck appropriate box(es):
rtanoioate otficesought:
n Poltical Committeo (PC)
see*+ orn 6 i I
E Electione€ring Communications Or9. (ECO)
n Party Executive Committee (PTY)
D lndependent Expenditure (lE) (also covers an
individual making electioneering communications)
D Check here if PC or ECO has disbanded
n Check here if PTY has disbanded
E Ch€ck hero if no other lE or EC reports will be filed
OFFICE USE ONLY
City oi tvtii.'ni Car"'; r,s
'.le Citi ()leh€ OlrveRec6
Date:
Time:
(5) Report ldentifiers
Cover Period:
do^sinar
rrom lL r gl t 11 To lL r3l r 11 Reportrype: *tUt1
E Amendment tr sprJi""tioiilo..t
(5) Contributlons This Report
Cash & Checks $ao
00
00
@
Loans $4
0Total Monetary $
ln-Kind $
(71 Expendltures This Report
l\4onetary
Expenditures $ _, _,_x 0o
Transfers to
Office Account _,_o 00
-JM
$
Total Monetary $
(8)Other Distributlons
$4 0!-
(s)TOTAL Monetarv Contrlbutlona To Date$ 3,, N5 00 (10)TOTAL Monetary Expendifures To Oate
$ _.___1t237_ Go
(1 1) Certification
It is a first degree miadomaanor for any person to falsify a public rocord (ss. 839.13, F.S.)
I certify that I have examined this report and it is true, conect, and complete:
E.(rype name) 3 andl6.E M %irX (r name)
tr dual perEon (only for PC and PTY)
x
Sign
dr,"rtr.*r D oupuy rr"."r"i
Signatu
,)
DS.OE 12 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS
By
x
/
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name E (2) l.D. Number
(3)coverperiod;2_tOlttl throushLrT'lt11 (4)Page lot I
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
citv. state, ZiP code
(8)
Contributor
Type i occupation
(e)
Contribution
Type
(1 0)
ln-kind
Description
(11)
Arn6ndm€nl
(12)
Amount
(6)
Sequence
I I
I
I I
tl
I
DS-DE 13 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
I
PORT - ITEMIZED EXPENDITURES
(1) Name (2) l.D. Number
1t1 covereerioo | 2 rl-,-lZtn,ourt'qaL_D (4) Page of I
(s)
Date
(1,l )
Amount
(10)
Amendmont
(s)
Expondlturs
TYPe
(8)
Pllrpoao
(add offico sought if
contrlbuuon to a
candidata)
(6)
Sequence
Number
Full Name
(Last, Sutfix, Flrst, Middlo)
Straet Address &
city, stats, zip code
t7t
OS.DE 14 (Rev' 11113)SEE REVERSE FOR INSTRUCTIoNS AND CODE VALUES