HomeMy WebLinkAboutGeneral - 20G03 CAMPAIGN TREASURER'S REPORT SUMMARY
(1) �' �t cJS Td/ OFFICE USE ONLY
Nam
(2)
Address (number and street)
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
❑ Candidate Office Sought "Z7v.4-/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
El 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�, l `� I To U�� 1 I Report Type:
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ Expenditures S _
Loans $ Transfers to
Office Account $
Total Monetary $ '
Total Monetary $
In-Kind $ --
(8) Other Distributions
10 TOTAL Monetary Expenditures To Date,
(9) TOTAL Monetary Contributions To Date ( ) S I D �-
`s,:: $
(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:
�e> S7-D-4—, (Type name)
(Type name)/ v L �'f 1 — Chairperson(only for PC and PTY)
❑ Individual(only for IE ❑Treasurer ❑ Deputy Treasurer ❑Candidate
or electioneering comm.)
-- -7
Signature/
Signature
SEE REVERSE FOR INSTRUCTIONS
DS-DE 12(Rev.1Ill 3)