HomeMy WebLinkAbout01: M11-16 Report(1)
(2)
CAMPAIGN TREASURER'S REPORT SUMMARY
S (S, d(L OFFICE US
Name
^ 7 0 1-^ ^ ^
Address (number and street)
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ii^oer ana street;^ ^
b\
E ONLY
City or Miami Gardons
RecGived h/hepffice of :;ie City Cleik
Date:_P^/^/^
Time:_30£z5
By; ^
(3) ID Number;
(4)
City, State, Zip Code
G Check here if address has changed
Check appropriate box(es): .
S^andidate Office Sought: fy(W ^
□ Political Committee (PC)
□ Electioneering Communications Org. (ECO)
□ Party Executive Committee (PTY)
□ Independent Expenditure (IE) (also covers an
individual making electioneering communications)
□ Check here if PC or ECO has disbanded
□ 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 j \ I I i /h jo // / / /^ Report Type:
□ Original □ Amendment □ Special Election Report
(6) Contributions This Report
Cash & Checks $ ■
Loans $
Total Monetary $
In-Kind
(9) TOTAL Monetary Contributions To Date
$ , . loo. oO'
(7) Expenditures This Report
Monetary
Expenditures $
T ransfers to
Office Account $
Total Monetary $
(8) Other Distributions
$
(10) TOTAL Monetary Expenditures To Date
$ ,
(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, comect, and complete:
(Type name) -£-(MlYH2,i>(2^ _L ^ ^
□ Individual (only for IE □ Treasurer lp..8^puty Treasurer
or electioneering comm ^ '' '
(Type name) OfL
[^^andidate □ Chairperson (only for PC and PTY)
X X
SignatumSignature
(Rev. 11/^DS-DE 12 SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name 0 d . J (2) |.d. Number
(4) Page(3) Cover Period I / I / / 4 through fl / ^ ^f of (
(5)
Date
(6)
Sequence
Numlser
(7)
Full Name
(Last Suffix, First, Middle)
Street Address &
City, State, Zip Code Type
(8)
Contributor
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
I ^
07) j
OfLA CL^
(72-2.0
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/ /
/ /
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DS-DE13(Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES