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HomeMy WebLinkAbout02: M12-16 Reportn CAMPAIGN TREASURER'S REPORT SUMMARY (1) Name (2) f7XZ-o Address (number and street) City, State, Zip Code en Check here if address has changed Oi!j; u' jvj , i i- I RecciveiQFRICBUSeONL^fe City CleiKDate: tlj[_3^p i 2_ Time: By. (3) ID Number: (4) Check appropriate box(es): Q^andidate Office Sought: Cv'W cCP M (/\vr\(□ Political Committee (PC) ^□ Electioneering Communications Org. (ECO) □ Check here if PC or ECO has disbanded□ Party Executive Committee (PTY) □ Check here if PTY has disbandedEx^nditure (IE) (also covers an □ Check here if no other IE or EC reports will be filedindividual making electioneenng communications) (5) Report IdentifiersCover Period: From £3^ / _^ / To jXl2j_l/C Report Type: MoQ-lL U Original □ Amendment O Special Election Report 6) Contributions This Report Cash & Checks $ , , . OZ) Loans otal Monetary n-Kind (7) Expenditures This Report Monetary Expenditures $ Transfers to Office Account $ Total Monetary $ (8) Other Distributions $^ t • 9) TOTAL Monetary Contributions To Date 5 . I Qoo.(10) TOTAL Monetary Experidttures To Date $ , , ©^ (11) CertificationIt is a first degree misdemeanor for any person to felsify 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) □ Indlviduai (only for IE □ Treasurer KK^puty Tieasureror electioneering comm.) (Type r^e) I 6-cindidate □ Chairperson (only for PC and PTY) X Signatur SignatuDS-DE 12 (Rev. |1/13)^-s^SEE REVERSE FOR INSTRUCTIONS Q • "^""^•"'■■^^"''ER'sreport-item.zedcontributions o t.u. i^uinoer (3) Cover Period ^'^i r ilL ,w u Ji '> / 'Z±lh_llL (4) Page / ^ //C\ 1 — (8)(5) Date (7) Full N (9)(10)(6) Sequence Number ame(Last, Suffix, First, Middle) Street Address &O^T^TcL t Contn-bubon-^' ^te. Zip Code [ Type Occupation TypoiJ //C I (CQ^LL*L CifZc}/ ® 0 I /IfCff ffiC L I / I / 2 / / / 1 / ^&v/7T I In-kind Description (11) Amendment (12) Amount DS-OE 13 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES