HomeMy WebLinkAbout19M03 CAMPAIGN TREASURER'S REPORT SUMMARY
` OFFICE USE ONLY
Name \ �t� City o.Mio)mi Ga ��s
Qrdcr
(2) L� F'ec .'.ve :i,f/7fr;ce c; .,ie i:;t; :leix
Address (number d street G Date:
q3��� 1 Time:
NQ f-L
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
dcandidate Office Sought:
❑ Political Committee(PC)
❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded
❑ Party Executive Committee (PTY) ❑ Check here if PTY has disbanded
❑ Independent Expenditure(IE) (also covers an ❑ Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(6) Report Identifiers 005
Cover Period: From / d / To / �� / � Report Type:
94riginal ❑Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ Expenditures $ QQ
Loans $ Transfers to
Office Account $
Total Monetary $
Total Monetary $
In-Kind $
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ I , \ Lb . 'Do $
(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) (Type name)
❑ Individ al(only for IE Treasurer ❑ Deputy Treasurer PACIandidate ❑Chairperson(only for PC and PTY)
or electio Bering comm.
Signature Signature
DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREkSURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name �� S P 1.• >v1� S (2) I.D. Number
(3)Cover Period / / 19
through / �� /� (4) Page �-- of
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(6) (Last,Suffix,First, Middle) (add office sought if
Sequence Street Address& contribution to a Expenditure
Number City,State,Zip Code candidate) Type Amendment Amount
DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name ��\ S� �.. ��.� �,` (2) I.D. Number
(3) Cover Period 3 / 0 1 / ( ) through 2�aj� (4) Page of
(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 Occupation Type Description Amendment Amount
vs rl
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES