HomeMy WebLinkAbout20M04 CAMPAIGN TREASURER'S REPORT SUMMARY j
- — L
(1) ry-) L L S 1--1 CD C) S Y __ OFFICE USE ONLY i
Name City of fV�iUn�i �Grdc,
(2) 1 4ti I N (,(1 7 C 0 C2.�' Rec,;ve,' ir,tF e Office ofthe 0f� 7I.
Address (number and street) Date: S
IL__J_ A �_' 0 L--7v15��L3 3 G'j L Time �"�7�1
City, State, Zip Code
❑ Check here if address has changed (3) ID Number.
(4) Check appropriate box(es):
❑ Candidate Office Sought:
❑ 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 v j l / / 9 To 0(/ / 3 C) / ? v Report Type: Z fJ M
❑ Original ❑Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ Expenditures $
Loans $ Transfers to
Office Account $ G
Total Monetary $ f
Total Monetary $ - ��-
In-Kind $ '
(8) Other Distributions
$
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ l�� °-00- $ t2
(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)(Y) Y L t-S 14 D 0 (Type name) W Y L L S H L�
u Treasurer Candidate ❑Chairperson(only for PC and PTY)
❑Individual(only for IE reasurer ❑Dep Deputy
or electioneering comm.)
X X C-
�natu Signature
SEE REVERSE FOR INSTRUCTIONS
DS-DE 12(Rev.11113)
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1)Name
��` (2) I.D. Number - - - ---
J� w �4_-. --..
(3)Covw Period l7� !� (� L"Othrough O l / (4) Paye of - -----
�) (6) fgl (10) (11)
DateFull Name Purpose
(6)
(Last,Suffix,First,Middle) (add ufficu Sought if contribution to a Expenditure
Street Address b
SpWlmq City,State,Zip Code candidate) Type Amondmont Amount
Number -- —
i
i
I
r
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES