HomeMy WebLinkAbout12: M10-17 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
1)OFFICE US
Name
2) n ( /Aa) (S) ji^fo)
Address (number and street) ^ T ,
/y]i^\ CTfw^ws . K 5^1^ 7
City, State, Zip Code
Q Check here if address has changed
4) Checj^ppropriate box(es):
andidate
□ Political Committee (PC)
O Electioneering Communications Org. (ECO)
□ Party Executive Committee (PTY)
□ Independent Expenditure (IE) (also covers an
individual making electioneering communications)
Checj^ppropriate box(es):
E ONLY
RECEIVED
NOV^8 REC'D
BY:
(3) ID Numt)er;
^ C C CCQ'^andidate Office Sought: Ga (fVI ^ ( (^A ^ X/^
□ Check here if PC or ECO has disbanded
n Check here if PTY has disbanded
O Check here if no other IE or EC reports will be filed
(5) Report IdentifiersCover Period: From | O / f / / ^ To f O / 3 i ' ^ Report Type: ^
U Original Q Amendment D Special Election Report
(6) Contributions This Report
Cash & Checks 5 , f,
Loans $ •
Total Monetary $
in-Kind
(7) Expenditures This Report
Monetary
Expenditures $
Transfers to
Office Account $
Total Monetary
(8) Other Distributions
$
(9) TOTAL Monetary Cont^butipps TqDate
$
notary Contributions To^ai. \0. ^0 (10) TOTAL Monetary Expendhures To Date
(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
O Individual (only for D Treasurer CXO^puty Treasurer
or electioneering.£p(Tir;r)
(Type name)
CTeandidale
Signature
oil J ffoi) A-^
Qlhairperson (only for PC and PTY)
Signatu
DS-OE 12 (Rev.SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name (2) I.D. Number
(3) Cover Period ( ^ / [_ / f 7'through / ^ 7^ (4) Page _1 of _J_
(5)
Date
(6)
Sequence
Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Contributor
Type Occupation
(9)
Contribution
Ii(Ee
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
I I ,1
007
Ufv/i 1 -fSoo
I n [) ^ S) A^i
ak
tvnJ (POcJ.cn^
K / >/ 'f
002^
'jTVcicSTorvJ r PoftC^
ofhip ^0.(N
/ /
/ /
/ /
/ /
/ /
DS-DE13 (Rev. 11/13)SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES