HomeMy WebLinkAbout19M07 CAMPAIGN TREASURER'S REPORT SUMMARY
IQ's �_ W"\S OFFICE USE ONLY
Name
(2) \t\rq �I \ \�y�c� ' City of Miami Gardcr,s
t\ `\ 1 ) l� Rec�lve�. nth Offi of,,he City Clerk
Addressnumber and street Date: /
Address (
) Time:
By. ;
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
[Candidate 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)
(5) Report Identifiers
Cover Period: From �� / / ��� To
/ ~lj l / ��,q Report Type:
❑ Original ❑ Amendment ❑ Special Election Report Y
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ Expenditures $
Loans $ _ Transfers to
Office Account $
Total Monetary $ (Q�>
Total Monetary $
In-Kind $ >
(8) Other Distributions
$ 1 ,
(9) TOTAL Monetary Contributions To Date (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:
C \ I,,TS (Type name ! �
(Type name) c Ja'fl�l1 �✓1 Y ' ( yP ) l��S
❑ Indivi al(only for IE ❑Treasurer [I Deputy Treasurer [1 Candidate [I Chairperson(only for PC and PTY)
or electio Bring comm.) VN
X X
Signature Signature
DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN T kSURER'S REPORT — ITEMIZE[ )NTRIBUTIONS
(1) Name (2) I.D. Number
(3) Cover Period / / through / / (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 T e Occupation Type Description Amendment Amount
6 W
5N
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES