HomeMy WebLinkAbout20M05 wCAMPAIGN TREASURER`S REPORT SUMMARY
OFFICE USE ONLY
7 C o v rz s
F- L;Its r
Address(number and street)
N I A M I &n iii V0 t ti'' S L 3 3 .S 6j.,
City, State,Zip Code
❑Check here if address has changed (3) ID Number
(4) Check appropriate box(es):
❑Candidate Office Sought: U .ti L -
❑ 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 / d / n To - / I Report Type:?C�.M o 5
❑ Original ❑Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ Expenditures $ 3��
Loans $ Transfers to
Office Account $ f�
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 have examined this report and it is true, correct, and complete:
(Type name) Y L u /-fC.)u :i 1L.
.;j I (Type name) �� -. r ` . �..!*� U Te n
❑Individual(only for IE ❑Treasurer ❑Deputy Treasurer ❑Candidate ❑Chairperson(only for PC and PTY)
or electioneering comm.)
natu Signature
04E 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS
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77
CAMPAIGN TREASURER'S REPORT—17EMIZED CONTRtBUT1CHNS
(2) I.D. Number
Cover Period 2,{- through !'�'S f _ / (4) Page of
(5) (7) (g) (g) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First Middle)
Sequence Street Address& Contributor Contnbuton in-Kind
Number City, State,Zi Codei Type I Occupation Type i Description Amendment Am
2S 3
7 .
i
� I
i
I 1
I
i
i
/ 1
I
1
13(Rw.11/13 _-- ._ -- --
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES