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CAMPAIGN TREASURER'S REPORT SUMMARY
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OFFICE USE ONLY �((
Name
City or Nli@mi Gardcris 1
� Rec4�ve.-' i;; he Office or the city Cle k i
{ } :.1 ' �7 nate:3 Of doted
Address (number and street) Time- n�
By. oo S
--
ity, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es): r
tg Candidate Office Sought: �9 l� E�✓' C.-C"�uM e( � 5 4 4 T
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❑ 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)
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(5) Report Identifiers
Cover Period: From 0�2_ I 0 .._ / 02C-) To e2d__/ ! Report Type: ,? M O..Z,
Original ❑Amendment ❑Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ O v o Expenditures $ C%Z�
Loans $ Transfers to
Office Account $
Total Monetary $
Total Monetary $
In-Kind
(8) Other Distributions
$ 00_
(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
(Type name) n l-�F L n (Type name) j4prA. a/ e, LL k
Individual(only for IE Treasurer ❑Deputy Treasurer Y;n7ddate ❑Chairperson(only for PC and PTY)
or electioneering co .)
X
Signature ; Signature
DS-DE 12(Rev.11113) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS �
(1) Name We 4r_k,a-&;r-lz--L, C �c�'LLeA (2) I.D. Number
(3)Cover Period ,1 d 1 ,�O through � / 20 {4) Page of
(8) (7) (8) (6) (10) (11) (12)
Dols Full Name
(a) (Last,Suffix,First,Middle) t
Sequence Street Address& Contributor Contrtution ln-kind
Number Citv.State Zip Code Type Occupation TYM DescrhXion Amwwnum Amount
0;' g
045
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DUN 13(Rev.11H3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES