HomeMy WebLinkAboutGeneral - 20G04 CAMP GN :REA �RER'S REPORT SUMMARY
OFFICE USE ONLY
(2) 1 City of Mir;rni Gardens
Recc'�' .e Office o,the City Clerk
dress (number a d street) Date: I�
]A Time: _ r✓'
City. State, Zip Code By.
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es): )
Candidate Office Sought: M—)421 ) 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 / / 26 To ay/ / Report Type:
Original F-1Amendment El 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 Wte (10) TOTAL Monetary Expenditures To Date
$ T OD- b $
(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 haye"examined this F�port and it is true, correct, and complete:
(Type name) JC --�-N�✓J (Type name �'� Z/4 - 1
❑ Individual(onr IE ❑Treasurer F] Deputy Treasurer andi to ❑Chairperson(only for PC and PTY)
,,–Gr electioneenn�Vpnmrn.)
X
Si ature S tur
DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS
(1) Name N (2) I.D. Number
(3) Cover Period D!7 / 1 / through u7 / f / l.1.6 (4) Page of f
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last,Suffix,First,Middle)
Sequence Street Address& Contributor Contribution In-kind
Number City,State,Zip Code T e -Occupation Type Description Amendment Amount
:�91t>d W 1-7 '77—t cqqxs A�
�9 s3I nMl �d �
M
14 H 7 Saar c)+
FL
DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES