HomeMy WebLinkAbout06: M04-17 Report(1)
(2)
CAMPAIGN TREASURER'S REPORT SUMMARY
Name
Ml sliO S)/of
Address (number and street)
/Vl/tWll K 3.TIX7
City, State, Zip Code
Q Check here if address has changed
OFFICE USE ONLY
City oi Miami Gardens
Time; fM
By
(3) ID Number:
(4) ChMk appropriate box(es):
0Candidate Office Sought: /Vj ,S ^
□ Political Committee (PC)
□ Electioneering Communications Org. (ECO) □ Check here if PC or ECO has disbanded
n Party Executive Committee (PTY) D Check here if PTY has disbanded□ Independent Expenditure (IE) (also covers an □ Check here if no other IE or EC reports will be filed
individual making electioneering communications)
N
(5) Report Identifiers^ J To ^ ^ y Report Type: ^^
□ Original □ Amendment □ Special Election Report
Cover Period: From
(6) Contributions This Report
Cash & Checks $ .
Loans $ •
Total Monetary $
$In-Kind
. dOO-OO
(7) Expenditures This Report
$
Monetary
Expenditures
T ransfers to
Office Account $
Total Monetary $
(8) Other Oistributions
$V » I
(9) TOTAL Monetary Contributions To Date
$ , . 00 •
(10) TOTAL Monetary Expenditures To Date
$ , , . 0^
(11) CertificationIt Is a first degree misdemeanor for any person to faisify a pubiic record (ss. 839.13, F.S.)
I certify that I have examined this report and it is true, correct, and complete:
(Type name)
□ Candidate □ Chairperson (only for PC and PTV^
(Type name) G'
□ Individual (only for IE □Treasurer Hjdeputy Treasurer
or electioneering eomm.)
Sign^i^'e Signati
DS-DE 12 (Re\t.^l1/13)SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name tM rUjr (2) I.D. Number
(3) Cover Period ^ / _! / I '] through ^ / 3>^ / ' ^ (4) Page of [
(5)
Date
(6)
Sequence
Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Ccxte
(8)
Contributor
Type Occupation
(9)
Contribution
I^ee
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
I'i, '}
O O j
aoJv/tM'V
ILU )d£Ntvitb ^
C-h
I
33 /f /
)f' 000 .(
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES