HomeMy WebLinkAbout20M01 CAMPAIGN TREASURER'S REPORT SUMMARY
(1) City o1,(�F� cru 11 Y ':letk
Rec�we: 1. e �i •�'•e i;ity
Name Date:
(Z) 2i lX Time:
Address (number s ree �3 V 55
�8��' � —
City, State, Zip ode
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es): �►
Candidate Office Sought: R&G� ClQ
❑ 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
Cov Period: From o l I / 20 To n ' / / Report Type:
Original ❑Amendment ❑ SpecialElectionReport
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $� , Expenditures $ ,
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
$ $
(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) 1i/�S' CAI- (Type name)
❑ Individual(only for IE ❑Treasurer ❑Deputy Treasurer ❑Candidate ❑Chairperson(only for PC and PTY)
or electioneering comm.)
X X
Signature Signature
DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS