HomeMy WebLinkAbout03: M01-17 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
(1) T^(^44of)Af^
Name
(2) (72:^0 /vJtO 5^0
Address (number and street)
mifr^l pCT^ojb
City, State, Zip Code
OFFICE USE ONLY
City 0/ MlDTii Gardci )S
RecrJved i/! the Office c; Iffe City Gleik
Date: f
Time : <•Time;
By. ^
O Check here if address has changed
(4) Check appropriate box(es):
(3) ID Number:
H^andidate Office Sought: cf ^£yV"i□ Political Committee (PC) ^
□ Electioneering Communications Org. (ECO)
□ Party Executive Committee (PTY)
□ Independent Expenditure (IE) (also covers an
individual making electioneering communications)
n 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 identifiersCover Period: From / / / / To j I f I Report Type;
□ Original □ Amendment □ Special Election Report
(6) Contributions This Report
Cash & Checks $ .
Loans $ ■
Total Monetary $ .
. fOd.co
In-Kind $
(7) Expenditures This Report
Monetary
Expenditures $
T ransfers to
Office Account $
Total Monetary $
(8) Other pistributions
$
(9) TOTAL Monetary Contributions To Date$ . , 3o(^. CD (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, correct, and complete:
(Type name) ^(Type name)□ Individual (only for IE //E^I Treasurer f^jxleputy Trea.siirer
or electioneering comm^andidate
Signature Signatu
□ Chairperson (only for PC and PTY)
DS-OE 12 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1)Name (1. I (2) I.D. Number
(3) Cover Period _/ / I / through _!_/2j_i !_3i (4) Page | of X
(5)
Date
(6)
Sequence
Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Contributor
Type Occupation
(9)
Contribution
lyee
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
t I li , I
Qoj
(Oi).
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES