HomeMy WebLinkAbout19M10 (Amendment) CAMPAIGN TREASURER'S REPORT SUMMARY
(1) ; 6,0 r 0 . OFFICE USE ONLY
City of Mia OFFICE
Gardc;;s
P111me� /� r Reciate:iv t t tt 20
ff4 of',he City Clerkn
(Z) y �C % -�J j C) rime:
Address (number nd street)
City,State,.Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
Candidate Office Sought: M 1 d H) e! �eQEW5A-7- 7±+- -5 _
❑ 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 L AN f To j z l l ) �' Report Type:)
❑ Original 'KAmendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ Expenditures $
Loans $ L <. 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 I h ve examined this report and it is true, correct, and Lcomplete: Y \
(Type name) EQ/ (Type name) (� 1�( C
❑ Individual(only for IE reasurer ElDeputy Treasurer ;andidate ElChairperson(only fpr PC n
or election ng comm.) 0�i
"X
Ig ature Ign
DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
-\v4(1) NameekonejCM (2) LD. Number
(3) Cover Period / J_ / L through ZlZ 1, l (4) Page �_ of f
(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
/21 l� C4
H'� '`" L A X So.
DS-DE 113(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES