HomeMy WebLinkAbout04: M02-17 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
(1) T(^ H-oj)OFFICE US
Name
(2)If I / r? T^?;: I M lo I
Address (number and street) 7 ~
City, State, Zip Code
D Check here if address has changed
(4) Checkappropriate box(es):wlleu^ d^iupiidit? Dux^es;.
E ONLY
City of Miami Gardens
Received Jn t/e Office or the City CIe>kDate; i. ftj .
Time: '
By. ,
(3) ID Number:
^
C^^Ian^ate Office Sought: ^
□f Political Committee (PC)
□ Electioneering Communications Org. (ECO)
□ Party Executive Committee (PTY)
n Independent Expenditure (IE) (also covers anindividual making electioneering communications)
□ Check here If PC or ECO has disbanded
G Check here If PTY has disbanded
G Check here If no other IE or EC reports will be filed
(5) Report IdentifiersCover Period: From 3^ / / / / ^ To 5L / ^ Report Type: ^
G Original G Amendment G Special Election Report
(6) Contributions This Report
Cash & Checks $ . , 5^-
Loans $
Total Monetary $
In-Kind
Repo
(8)er Distributions
(7) Expenditures This
Monetary
Expenditures $
T ransfers to
Office Account $
Total Monetary^ $
(9) TOTAL Monetary Contributions To Date$ , , ^- (fO (10) TOTAL Monetary Expenditures To Date
$^ t I •
(11) CertificationIt 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)
D Individual (only for 1^^ □ Treasurer S^iputirTreasureror electioneering rtl jgandidate □ Chairperson (only for PC and PTY)
X
Signature
DS-DE12 (Rev. 11^43) ^SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN 1 ,x_ASURER'S REPORT - ITEMIZED VJTRIBUTIONS
(1) Name (2) I.D. Number
(3) Cover Period / _| / ^ ^through (4) Page j_ of _f_
(5)
Date
(6)
Sequence
Number
(7)
Full Name
(Last, Suffix, First Middle)
Street Addr^ &
City. State. Zip Code
(8)
Contributor
Type Occupation
(9)
Contribution
Type
(10)
in-kind
Description
(11)
Amendment
(12)
Amount
^ I I
Oc i
' CO,
XkTC
fvicvj (Sy Si ' eft ^-0 vo
/ /
/ /
/ /
/ /
/ /
DS-DE13 (Rev. 11/13)SEE REVERSE FOR iNSTRUCTIONS AND CODE VALUES