HomeMy WebLinkAbout13: M11-17 Reportr
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) £t<.~WL IG-~ ~ R
DEC 0
Name ~
(2) fl{ t--ivJ I f-1 §. I 't1 I 61
Address (number and street) 1 L
/}? I~ I ~ ~ 'V-) { 3>-3 ( £ 7
City, State, Zip Code I
0 Check ere if address has changed (3) 10 Number: ------------------
(4) Che appropriate box(es):
andidate Office Sought: LA 7'1 <rf rn I~ I
0 Political Committee (PC)
0 Electioneering Communications Org. (ECO)
0 Party Executive Committee (PTY)
0 Independent Expenditure (IE) (also covers an
individual making electioneering communications)
0 Check here if PC or ECO has disbanded
0 Check here if PTY has disbanded
0 Check here if no other IE or EC reports will be filed
(5) Report Identifiers
Cover Period: From Jl l r I f 1---To 1L I 3 u I I T Report Type: tYl/ J --r;
0 Original 0Amendment 0 Special Election Report
(6) Contributions This Report ~
Cash & Checks $ , /, ·
(7) Expenditures This Report
Monetary
Expenditures $ I --------
Loans $ , , (uo. C){) ---------
Total Monetary $-/-·
In-Kind $ I I --------
Transfers to
Office Account
Total Monetary
$
$
-------
I ------
(8) Other Distributions !ii -bo C/'0 $ ___ , ___ , . __ _
(9) . TOTAL Monetal}f Contrib~i~s To Date
$ _,_l!2 ,]jj . SD (10) TOTAL Monetary Expenditures 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:
,......... --:1
(Z....f-tA/1<) fL ~ !)~ {Type name) G-l-tf-Ag 0 (L j_q {Type name)
0 Treasurer 'ije?~idate 0 Chairperson (only for PC and PTY)
X X
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT-ITEMIZED C NTRIBUTIONS
{2) I.D. Number
{3) Cover Period _1_\ I __ I ~ through _/_( I ~ I _!_1-{4) Page \ of I
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State Zip Code Type OccuQation Type Description Amendment Amount
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001
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OS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES