HomeMy WebLinkAbout19M09 (1) C)L �U FFICE USE ONLY
Name
7
(2) ��� r� J If il�) C-U 2 '7 COCJL
Address (number and street) r .:_ slip F u4 ie t_it CI
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check ppropriate box(es):
Candidate Office Sought: C.� r
❑ 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 / O / To / / Report Type:
❑ Original ❑Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $�, Expenditures $ (J
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 Ihaave examined this report and it is true, correct, and complete:/�
(Type name) I S I�- �'e_� i Hy J.S O A-) I (Typ"me)
❑ Individual(only for 1 reasurer ❑Deputy Treasurer ( andidate ❑Chairperson(only for PC and PTY)
or electioneering comm.
X
! Si_nature I Sig afore
DS-DE 12(Rev. 11(13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name 01W ( PT 4 OUS l CAV (2) I.D. Number
(3) Cover Period / / / through (4) Page of
j (5) (7) (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 Type Description Amendment Amount
I
DS-DE 13(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES