HomeMy WebLinkAbout19M12 CAMPAIGN TREASURER'S REPORT SUMMARY
(1) L/U nzl pity o I Q {CE USESONLY
Nga,,me�J x�',I q p�j�1 �,/ Rec•.,ve r;e of .,�e Cit; :uletic
(2) �Gt/�!� />r (/l! UO TJX/ J+�'� Date:��t a.0e?D
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City, State, k2p Code
❑ Check here if address has changed (3) ID Number:
(4) Chick appropriate box(es): �.
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Candidate Office Sought: / jai �
❑ 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 To 9 Report Type: f
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $� , Expenditures $
Loans $ Transfers to
Office Account $
Total Monetary $
Total Monetary $
In-Kind $ � � •
(8) Other Distributions
$ _-D ,
(9) TOT A Monetary Contributions To Date (10) TOT 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) �j (Type name)
❑ Individual(only for IE ❑Treasurer ❑Deputy Treasurer ❑Candidate ❑Chairperson(only for PC and PTY)
or electione c mm.)
X X
Signature Signature
DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS