HomeMy WebLinkAbout09: M07-17 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
(1)
Name
(21 III sT.
Ad(jress (num^ and street) ^
A\//Vn( ^
City, State, Zip Code
Q Check here if address has changed
(4) Ch^ appropriate box(es):
OFFICE US
(3) ID Number;
Ch^ appropriate box(es):
E ONLY
City oJ MijjTii GardensReciiveii^e O^jce of ihe City Clers
Date:
'm
^ r
H^ndidate Office Sought: ('P
□ Political Committee (PC)
□ Electioneering Communications Org. (ECO)
D Party Executive Committee (PTY)
□ Independent Expenditure (IE) (also covers an
individual making electioneering communications)
□ Check here If PC or ECO has disbanded
□ Check here if PTY has disbanded
Q Check here if no other IE or EC reports will be filed
(5) Report Identifiers
Cover Period: From Report Type:
□ Original □ Amendment □ Special Election Report
(6) Contributions This Report
Cash & Checks $ _ _. I ' yjy 00
Loans $ . • •
Total Monetary $
In-Kind
(7) Expenditures This Report
Monetary
Expenditures $ , . -^73 •00
Transfers to
Office Account $
Total Monetary $
(8) Other Distributions
$
(9) TOTAL Monetary pontrjbutmns To Date
$
y Contributions To It.(10) TOTAL Monetary Expenditures To Date$ , . f^o. 00
(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:
□ Candidate □ Ctiairperson (only for PC and PTY)
(Type name) 0 ^
□ Individual (only for IE □ Treasurer [iy6eputy Treasurer
or electioneering comm.)
SignatuT Signawt^
DS-DE 12 (Rev:i1/13)SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(2) I.D. Number
(3) Cover Periodiod 2l / J_ / through 7-/ g I / ' ? (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
oof
T Gffe
f
,n.^, 7
oo-v
i/j t^f
g.2,0 ^7
3,'^ 4-(.7^
lAvaJ
iCM
^ I ^
, ft 'yii
S
g
I
^00.CO
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN
(1) Name f:=fL[hPi
TREASURER'S RE
r /",1-POAfl^
REPORT - ITEMIZED EXPENDITURES
(2) I.D. Number
(3)Cover Period _ (4) Page ^ of J_
(5)
Date
(6)
Sequence
Number
(7)
Full Name
(Last 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
7 m
00 I
tiS
J_L
1_L
jU^
U.
LJ^
DS-DE14 (Rev. 11/13)SEE REVERSE FOR INSTRUCTiONS AND CODE VALUES