HomeMy WebLinkAbout19M01 CAMPAIGN TREASURER'S REPORT SUMMARY
OFFICE USE ONLY
City o, MiLmi Gardciis
(Z► 1 i� �,� j 3 S_?_ o l— - Rec,'ve7 i;,, t e Office o,;fie Cit k
Address(number and street) Date: l9
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Sime:_3��_ /''j
City State Zip Code fay ` -
Check here if address has changed (3) ID Number
(4) Check appropriate box(es) - ---__
C41"ate Ofrice Sought M r r>Yh i�rfi,� 3 _Gf t GO"t,
Q Politica!Comm rttee i PC! - -- --T_ `
Electioneering Commur.pcations Org IECO) ❑Check here if PC or ECO has disbanded
Party Executive Committee(PTY) U Check here if PTY has disbanded
Independent,Expenditure(IES !also covers an []Check here if no other IE or EC reports will be filed
individual making electioneering commurncationsi
(5) Report Identifiers
Cover Penod From _� - - To 1 3( I Report Type
L_ Ongina- `7 Amendment ❑Special Elect�c^ Report
(6) Contributions This Report (7) Expenditures This Report
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Monetary
Cash & Checks 5 ( 0 W Expenditures S /
Loans S _ Transfers to
Office -,ccount 5
Tota! Monetary 5 ----
Total Monetary $ �
In-Kira S
(8) Other Distributions
S!
(9) TOTAL Monetary Conibutions To Date (10) TOTAL Monetary Expenditures To Date
- —r
(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 tr:,e correct ano complete
'ype name}
_ _ 'Type�ame�
ndiyoua,(onf for IE �ul Trda3�XC----� jreaq,rrr
comm t orate D Chairperson(only for PC ano PTY)
X
Signature
Signature
t?S-0E 12(Rev 11113)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) NameJ6A•-1 - (2) I.D. Number ------ -
(3) Cover Period r / I / I�- through 1 3 I I 2L (4) Page _ of —
1$4 ----- _— i7? �- ,8)-- ---1--- 191 i --(10) 011)----`-�--.-- (12---.�
date Full Name
16; (Last. Suffix Fust.Middle) !
Sequence Street Address& Contnbutol Contribution In-kind
Number City.St te
.Slate ZIP(Ctode ' Type i Occupation t ape - Y Descriptionf p m +I Amount
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too! r�►i t . n 3 I —
arr
2-N aO &4j
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1
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SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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