HomeMy WebLinkAbout01: M07-17 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
(1) _
Name
(2) Ih9i)[ ^
AC aress (number and street) , /
-City.^State, Zip_Code '
OFFICE USE ONLY
City cj] mi Garde: )S _
ftficsive'^ i« the Ottice cx .ne Oity .>iet
•By n
Q Check here if address has changed
(4) Check appropriate box(es): ^
^Candidate Office Sought: (/^OlJAffjl^ -f^ (p
(3) ID
□ P
Number:
olitical Committee (PC)□ Electioneering Communications Org. (ECO) □ Check here if PC or ECO has disbanded
□ Party Executive Committee (PTV) □ Check here if PTY has disbanded□ Independent Expenditure (IE) (also covers an □ Check here if no other IE or EC reports will be filedindividual making electioneering communications)
(5) Report IdentifiersCover Period: From _^ / _^ / To ^j_l Report Type:
IS Original □ Amendment □ Special Election Report
(6) Contributions This Report
Cash & Checks $ . , • m
Loans $
Total Monetary $
In-Kind $
•m
(9) TOTAL Monetary Contributipns To Date$ . ■ W.
(7) Expenditures This Report
MonetaryExpenditures $ , ■ ^ /
Transfers to
Office Account $ , , .
Total Monetary $■M-93.
(8) Other Distributions
$
(10) TOTAL Monetary Expenditures To Date
» .
(11) CertificationIt 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) /llPih/hfh . (Type name)
□ Individual (only for IE B^freasurer D Deputy Treasureror electlonjffiring comm.)S Candl^ChalfpBfBqntonly for PC and PTY)
Signatui
DS-DE 12 (Rev. 11/13)
U
X
Signatu
SEE REVERSE FOR INSTRUCTIONS
11 / CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name (2) I.D. Number.
(3) Cover Period through (4) Page / of /_
(5)
Date
(6)
Sequence,
(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)
AmountNumber
HL fOivii
olmnt
112^
iWfr/ni
3210
lAMUt^110 d w 1215//\l'l/tT'
£L
93
/Yl/Vyni ft
OB.113^
I_L
2-L
LJ.
LJ^
LJ^
DS-DE14(Rev. 11/13)SEE REVERSE FOR INSTRUCTiONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name /iLf^(2) I.D. Number
(3)Cover Period through 1!L:3L>J!L (4) Page / of _l_
(5)
Date
(6)
■Sequence,
Number
ML
AJhJl
/ L
/ /
/ /
/ /
/ /
(7)
Full Name
(Last Suffix, First, Middle)
__StreetAdd[ess-&
City, State, Zip Code
ML
DS-DE 13 (Rev. 11/13)
(8)
-Contributor,
(9)
-Contribution-
Type Occupation
LL 'A.
Type
LM-
m.
(10)
-In^kind-
Description
(11)
Amandment
(12)
Amount
CO
m.
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES