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HomeMy WebLinkAbout19M09 CAMPAIGN TREASURER'S REPORT SUMMARY (�,_ D �V `S OFFICE USE ONLY NameCity o;Mimi Gardcns q Recr ?ve-, in, t e OfF e of the City Cie V ` (2) \� D� C ,� ��-� Date: / qlO P/9 ,address (number and street) 33 t �C� Time: - I By: City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): D-15andidate 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 _\!�_ / �Z3 / a0Aq Report Type: �iginal ❑Amendment ❑Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , r Expenditures $ Loans $ , Transfers to Office Account $ , Total Monetary $ , Total Monetary $ , In-Kind $ , (8) Other Distributions (9) TOTAL Monetary Contributions To D (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: (Type name) S S (Type name) ❑Individual only for IE Treasurer ❑Deputy Treasurer ❑Candidate ❑Chairperson(only for PC and PTY) or elecGonee g comm.) c X X Signature Signature DS-DE 12(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS (1) Named �_ ��� (2) I.D. Number (3) Cover Period V / �� / }`�\ through / �p / �1 �C(4) Page of (5) m (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 T Description Amendment Amount ad el a�� `ao�so w a 16 00,E i r DS-DE 13(Rev.11/13 SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES "CAMPAIGN ASURER'S REPORT— ITEMIZED EXPENDITURES (1)Name h1 5' ��� A�j1S (2) I.D. Number (3)Cover Period /�_/ V, hrough �b (4) Page of (5) (7) (8) 1, (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 L q4k, -A Proc�VC�10n p , DS-DE 14(Rev.11/13 ) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES