HomeMy WebLinkAboutGeneral - 20G04 �1 `1T��CAMPAIGN TREASURER'S REPORT SUMMARY
(1) 11_ tC_,i W 2 l� -sco- � , f es - --- City oi�JI�FICiE aSa ONLY
Name Recofver'. it the Office of the City Cleh<
(2) dui Nw t :�Ay 51Ye Date:
Address (number and street) - Time:--5.',
M 10 W i FL _3 a�o _ _
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es): ��
[`Candidate Office Sought: M t(, m C- avrtens C� couoc'd _.S_ CU 3
❑ 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 / t t / C' To 1 ] / Report Type:t�-
❑ Original ❑Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks Expenditures $ �'� l0
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
(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) V1 (Type name) mo m-
❑Individual(only for IE [1,71'easurer ❑Deputy Treasurer 0,1;andidate ❑Chairperson(only for PC and PTY)
or electioneerin mm.)
X
Signature 1 Si
DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES
(1) Name (2) I.D. Number
(3) Cover Period ZC..i through 7 (4) Page ( of
(5) (7) (8) (9) (10) (1 1)
Date Full Name Purpose
(6) (Last,Suffix, First, Middle) (add office sought if
Sequence Street Address& contribution to a Expenditure
Number City,State,Zip Code candidate) Type Amendment Amount
3 �01TGS rwJ(0 PIS I l"f k 1- pmt fig'
7c�{ rJ�.v t 453rd Sfi ` 1/'%►'1S
Mictry)I TL
DS-DE 14(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES