HomeMy WebLinkAboutGeneral - 20G07 CAMPAIGN TREASURER'S REPORT SUMMARY
(1) elfj OFFICE USE ONLY
a /ems \ city c:VIia7mi Gar( ins
(2) C J � E.e_ 'v� thy— t c;;ne City Clerk
Address number an treet
Date:)901
( ) Time:�.�-
M 2� - 10 Time:
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es): )
c-kCandidate Office Sought: H1
❑ 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 / / ) To D / / Report Type:
)Y(Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ ,,'��j �; t_> 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
$ �7 $ i '
(11) Certification
It is a first degree misdemeanor for any person to falsify a publi ecord (ss. 839.13, F.S.)
I certify th t I ha examined this re ori and it is true, correct, and complete-
(Type name) , J r-I� 6 (Type name) 1j r
❑Individual(onk for IE Treasurer ❑Deputy Treasurer _LICandida[ ❑Chairperson(only for P and PT17
or election ee� g comm.) �-
X
gnature SI e
DS-DE 12(Rev. 11/13) SEE REVERSE FOR INS'*UCTIONS
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS
(1) Name 6 (2) I.D. Number
(3) Cover Period through 08 / tj /, (4) Page f of
(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 Type Occupation Type Description Amendment Amount
&O-s-004H, S645
14") 4
5P
�t
1f71 HYVft k, t Ol5.de
M I 33H)'Dez
2 ;&)
g6�� �►/� 2 z 4 �1 z.�=6v
DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAI N T EASURER' PO T- ITEMIZED EXPENDITURES
(1) Name (2) I.D. Number /
(3)Cover Period�/ �/ through /_ /74:::�) (4)Page of /
(5) (7) (8) (9) (1 0) (11)
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
U ,I
L ��� � � 1
�*4 Y
.19
J6 ej� I. Bb 2-t,--
i�,A4 R 33 jSZ-
,lcj
DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES