HomeMy WebLinkAbout05: M03-17 Report(1)
(2)
CAMPAIGN TREASURER'S REPORT SUMMARY
Name ^
Ifi iCl "^1 . Jf-{ o I
Address (number and street) ' ~
f-C ^1(^7
City, State, Zip Code
City oOrt^EQ«6lt9ftLy.. p,-,T,Received tt^ Office oi ^ne oity ^le
Time;.
By.—
(3) ID Number:
(4)
O Check here if address has changed
Che^ appropriate box(es): ^
ID^ndidate Office Sought: Ql ^ ^ ^ ^ ^ OCv^ J ^ ^
□ Political Committee (PC)
□ Electioneering Communications Org. (ECO)
□ Party Executive Committee (PTY)
□ Independent Expenditure (IE) (also covers an
individual making electioneering communications)
G Check here if PC or ECO has disbanded
□ Check here if PTY has disbanded
G Check here if no other IE or EC reports wiii be filed
Cover Period: From ^ / I
G Original G Amendment
(5) Report Identifiers
^ !_7- Report Type: ~
G Special Election Report
(6) Contributions This Report
Cash & Checks $ . [ i 3^ • 0 ^
Loans $
Total Monetary $
In-Kind
(7) Expenditures This Report
Monetary
Expenditures $, (o'^.CfO
T ransfers to
Office Account $
Total Monetary $
(8) Other Distribution^-
$
(9) TOTAL Monetary Contributions To Date
$ , ■ qO
(10) TOTAL Monetary Expendi^es To Date$ , . hf.oxi
(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)□ Individual (only for IE □ Treasurer [^^p^put/Vreasurer
or electioneering comm
£
(Type name)
[^^pfindldate □ Chairperson (only for PC and PTY)
Signatun
DS-DE 12 (Rev.f11JJ3)^
Sidnatu
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name (2) I.D. Number
(3) Cover Period 3 / ^ / I ^ through 2 / ^ ^(4) Page ( of
(5)
Date
(6)
Sequence
Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Contributor
Type Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
oo1
0^)^^ C{
6T.
r^(M' P*-
9'
00 2_
Or\/rrnA(
Kc 0/ 9J2
Avc '/Wi(Vvv\ ^ ^ 3>3^^
/ /
/ /
/ /
/ /
/ /
DS-DE13 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIG^iIREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name _Lr. 44QDA"r^ (2) I.D. Number
(3) Cover Period I /J2through (4) Page.i of (_
(5)
Date
(7)
Full Name
(LasL Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Expenditure
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
^ 1^3. ^P^TlJ^^C^\ P&If
fV\o»o
01? 1
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-OE14 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES