HomeMy WebLinkAbout19M09 CAMPAIGN TREASURER'S REPORT SUMMARY
(1) �✓ / �✓ �Q � L ,I1�_ '.:ity@F��-i41��rr�NlsY
Name Rec._�ve i, the Office 'ie City Cle
02 Date: 1 d 1 it ( d
(2)
Time: S :0
Address nu ber a d street
(Aam , I .
City, Stat ip Code
❑ Check here if address has changed (3) ID Number:
(4) Che appropriate box(es):
Candidate Office Sought.
❑ 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
Co v Period: From / �� / / To / 3 / Report Type:
� � ��G
Original ❑ Al
dment ❑ Special Election Report fit//
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ Expenditures $
Loans $ , Transfers to
Office Account $
Total Monetary $
Total Monetary $
In-Kind $
(8) OtheDistributions
$ ,
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ $ 0
(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 an it is true, correct, and complete:
(Type name) 06&- /` (f (Type name)
❑ Individual(only for IE ❑Treasurer ❑ Deputy Treasurer ❑Candidate ❑Chairperson(only for PC and PTY)
or electioneerin comm.)
X X
Signatur Signature
DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS