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CAMPAIGN TREASURER'S REPORT SUMMARY
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(1) �� . �/rrk.,.,, a l/ _ -- City of Mbpr"aMOMLY
Name Rec;.;ve�-. ;; the Office of, e City Cie k
j (2) L ° C+ Date:.�l� 016?09
Address(number and street) Time.
MM frwt i ^r i. .nf By.
City, State, Zip Code
[ Check here If address has changed (3) ID Number.
(4) Check appropriate box(es)
i
Q Candidate Office Sought
1 ❑ Political Committee(PC)
❑ Electioneering Common nations Org (ECO) ❑Check here if PC or ECO has disbanded
❑Party F—cutive 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 Identiflers
Cover Period From ! To U I > / if Iq Report Type
Q Original ❑Amendment ❑Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
C,ish & Check,, $ Expenditures S
Loans $ Transfers to
Office Account $
Total Monetary $
Total Monetary $
In-Kind $
(8) Other Distributions
S -
9 TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
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(11) Certification
It Is a first degree misdemeanor for any parson to falsity a public record (ss 839.13, F.S.)
I certify that I have examined this report and it is truo,correct,and complete
(Type name)
(Type name) _s - n-- _
— --- Choi non(oni for PC and PTY)
❑Individual(only for IL ❑Tressurw ❑Doputy Treasurer ❑C+ndidate ❑ rDe Y
w electioneering comm 1
X
X -
Signature Signature
SEE REVERSE FOR INSTRUCTIONS
DS-DE 12(Rov. 11113)
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS
(1) Name _A ✓ e- (2) I.D. Number
(3) Cover Period / (_ / through / t/ / - (4) Page of
IS) (7)_ (8) (9) (10) (12)
Date Full Name
(6) (Last,Suffix,First.Middle)
Sequence Street Address& Contributor Contribution In-kind
Number City.State Code Type Owupatkm Type De tion A"'"dffwd Amount
I
/ 1
DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(1)Name CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
�ir^ %r r—
_ (2)I.D. Number
(3)Cover Period J J ( ! through /�(_/ ( (4)Page of
(S) (7) fi ) (9) (10) (��)
Date Full Name Purpose
(6) (Last,Suffix,First,Middiol (add office sought If
Sequence Street Address d f contribution to a Expenditure
Number City.State,zip Coae candidate) Type Amendment Amount
I „ n
DS-DE 14(Rev 11113) SEE REVERSE rOR INSTRUCTIONS AND CODE VALUES