HomeMy WebLinkAbout10: M08-17 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
1)
2)
Name ^
III (Juj # Io I
Address (number and street) ^ <-> /
City, State, Zip Code
OFFICE USE ONLY
D Check here If address has changed (3) ID Number.
4) Check appropriate box(es);
[Q^andidate Office Sought: ^
Q Political Committee (PC)
□ Electioneering Communications Org. (ECO)
□ 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
G Check here if no other IE or EC reports will be filed
(5) Report IdentifiersCover Period: From ^ / f / _f?_ To ^ / 7 f / ' 7 Report Type: I ^
G Original □ Amendment □ Special Election Report
(6) Contributions This Report
Cash & Checks $
Loans $
Total Monetary
In-Kind
(7) Expenditures This Report
Monetary
Expenditures
Transfers to
Office Account $
Total Monetary $
(8) Other [^tributions
$
(9) TOTAL Monetary Contributions To Date$ . ■?.
(10) TOTAL Monetary Expenditures To Date
$ , , W. 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:
(Type name) irf 0 O (I- ^ G lr\ AfL 0
Treasurer □ D^uty Treasurer□ Individual (only for IE
or electioneering coiren.)
Signature
(Typejiame)
(Candidate O Chairperson (only for PC and PTY)
Signatu^ ^
DS-DE12(Rev. 11/SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED COn i RIBUTIONS
(1) Name 0 ^ ^(2) I.D. Number
(3) Cover Period ^ / _[ / ' V through ^ ^ I / ' ^(4) Page i_ of i
(5)
Date
(6)
Sequence
Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code Type
(8)
Contributor
Occupation
(9)
Contribution
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
1/ '„1
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DS-DE13 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES