HomeMy WebLinkAboutGeneral - 20G05 CAMPAIGN TREASURER'S REPORT SUMMARY
OFFICE USE ONLY
City Qi l i 'JafCj,;i,S
Nam Rec •ve.''s;;the Office of;�:e eity Cleri
(2) �3 Hu2O 7 �i�"IQ� date: 3 31 DO
Ad6ress (number and street) Time: lt•76 A
City, State, Zip Code
L Check here if address has changed (3) ID Number'
S
(4) Check appropriate box(es):
� 1
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 0 -7
To OZ 1 1 LJ l c )r Report Type: ;_^
r.!Original ❑Amendment ❑Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary I
Cash & Checks r3D Expenditures $
Loans $ _ 1'ransfers to
Office Account $ i
Total Monetary $ ��
-- i
Total Monetary $ dC>
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) P ��
�iL [[(, � _ (Type name)ay�tR�c/!�L
El Individual(only for IE �Traasuror [:1 Do"Trsa�xar
ardidate I]ChakpKaon(o*for PC and PTY)
or electioneering comm.)
Signature Signature
DS-0E 12(Rev.1111113) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(y) Name TN- til / r (r te j �L�IQ- (2) I.D. Number
(3) Cover Period —9 I A l 0 "1 through / � / ,90;M (4) Page of
(5) 7,' (8) (9) 0 0) (11) (12)
Date Full Name
(6) (Last.Suffix, First, Middle)
Sequence Street Address& Contributor Contribution In-Kind
Number City, State,Zip Code Type Occupation Type Description Amount
07, 120 • r
Z -rovl,
L4 0
1
r �
i
i
i
1 !
i
08-DE 13(Rev.11N3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES