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HomeMy WebLinkAbout20M04 A CAMPAIGN TREASURER'S REPORT SUMMARY (1) ",� [%D wit, ©wf� ILY Name Rer.4;v�; . :t e Offic of the City CI 'k (2) a'u� treet) r anWeiU Address (numb d � �' l� ? 7s 3 55 , _ . City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check-appropriate box(es): ('Candidate Office Sought: i&ie&711Qz ❑ 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) (6) Report Identifiers p�L Cover Period: From / / 49,b To � l 3D l � Report Type: — EVriginal ❑Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ Expenditures $ Loans $ Transfers to Office Account $ Total Monetary $ o , Total Monetary $ In-Kind $ (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date (10) TOTg11-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) "P " � � d e__ (Type name) ❑ Individual(only for IE ❑Treasurer ❑Deputy Treasurer ❑Candidate ❑Chairperson(only for PC and PTY) or electionee ng comm.) X G� X Signature Signature DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS