HomeMy WebLinkAbout11: M09-17 Report/
(1)
(2)
CAMPAIGN TREASURER'S REPORT SUMMARY
Name
.11 /JtO iS-3
Address (number and street) ^ ~~n~o / «
City, State, Zip Code
O Check here if address has changed
OFFICEREcm
OCT
BY
(3) ID Number;
vE
2011
(4) Check appropriate box(es): ^ .
^Candidate Office Sought:
□ Political Committee (PC)
G Electioneering Communications Org. (ECO) G Check here If PC or ECO has disbanded
G Party Executive Committee (PTY) G Check here If PTY has disbanded
G Independent Expenditure (IE) (also covers an G Check here If no other IE or EC reports will be filedindividual making electioneering communications)
(5) Report IdentifiersCover Period: From G^/ To 5^ / / t Report Type:
G Original G Amendment G Special Election Report
(6) Contributions This Report
Cash & Checks
Loans
s , , ^
Total Monetary $
In-Kind
(7) Expenditures This Report
Monetary
Expenditures $
T ransfers to
Office Account $
Total Monetary $
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date$ , . ^(>0 ■ <20
(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)
□ Individual (only for IE QTtyasurer C^peputy Treasurer
or electioneering comi "
(Type name)
□ Candidate n Chairperson (only for PC and PTY)
X
Signature Signat
DS-DE 12 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name J_(2) I.D. Number
(3) Cover Period through (4) Page [_ of l_
(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
i"'»f'
Oo I
T
I'll!
41^
,00
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DS-DE13 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES