HomeMy WebLinkAbout19M10 CAMPAIGN TREASURER'S REPORT SUMMARY
J
OFFICE USE ONLY
Name RECEIVEDz
(2) cJ
4
A ress (numbe,and street) NOV Q 7 RECD 5:Flo
City, State, Zip Code
�..
❑ Check here if address has changed (3) ID Number:
(4) Cheek appropriate box(esg: � �� � ��it Candidate Office Sou ht:
❑ 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 / n / To / / �� Report Type:
Original ❑Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ 'V Expenditures $
Loans $_D Transfers to %1
Office Account $
Total Monetary $ >
Total Monetary $ ,
In-Kind $ � >
(8) Other istributions
$ -
(9) TO TA Monetary Contributions To Date (10) TOTA4 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:
(Type name) A1z (Type(Type name)
❑Individual(only for IE reasurer ❑Deputy Treasurer ❑Candidate ❑Chairperson(only for PC and PTY)
or electi ring comm.)
X 14 dy X
Signature Signature
DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS