HomeMy WebLinkAbout19M11 CAMPAIGN TREASURER'S REPORT SUMMARY
(1) 2 `e,5 o v,�� y 1�J OFFICE USE ONLY
Name
(2) � rity of Mimi-Gard.ns
i. ) '`7 a p fir"t Recc;ve .in th Of ice of ,he city Clerk
Address (number and street) Date: � +-�---
City, State, Zip Code -�
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
3'Candidate Office Sought: 71 p Aj
❑ 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 ��_ I I To / �, l c j Report Type: _� 7
❑ Original ❑Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
,r Monetary
Cash & Checks $ Expenditures $ "
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
_ L')U -
(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: f
(Type name) (� c�' U . o (Type name)
❑ Individual(only for IE reasurer ❑ Deputy Treasurer
andidatea, eh rpC rson(only for PC and PTY)
or electioneering comm")
X
X Signature UCTION
Signatur SE FOR INSTRUCTIONS
DS-DE 12 (Rev. 11/13)
CAMPAIGN TREASURER'S REPORT — ITEMIZI CONTRIBUTIONS
('1) Name 1 )4 (0 C) ��j� (2) I.D. Number __—__---
(3) Cover Period through ji� / 3L / 'L:Y K (4) Page Of
(5) (7) (8) (9) (10) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address& Contributor Contribution In-hind
Number City, State,Zip Code Type Occupation Type Description Amendment Amount
I I
DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES