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HomeMy WebLinkAboutGeneral - 20G04 CAMPAIGN TREASURER'S REPORT SUMMARY (1) ,y c,i �' I`�-E�c� S c ��i OFFICE USE ONLY Named (2) !a 2 ! /V ' 7 Address(number and street) 1 "q 4,1 1 CY!q 3' S V City, State, Zip Code ❑Check here if address has changed (3) ID Number: (4) Check appropriate box(es): ❑Candidate Office Sought: (D/�j L-:- 0 ❑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 ? / / Z, c- To ,7 / 1 O Report Type: ❑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 $ (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) (Type name) M G ❑Individual(only for IE ❑Treasurer ❑Deputy Treasurer ❑Candidate ❑Chairperson(only for PC and PTY) orebcUoneering comm.) Sjqn13tUre Signature I054)E 12(Rev.11113) SEE REVERSE FOR INSTRUCTIONS