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HomeMy Public PortalAboutTreasure ReportsCAMPAIGN TREASURER'S REPORT SUMMARY (1) lb�Q4.6.4- Q OFFICE USE ONLY Name /' (Z) /A/O /V. f9 C6_ 44 Address (number and street) 6 of ^ o-✓jA_'.t fes• Yr -3 City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): i Candidate Office Sought: mJ'� 67 Lit Je 17'4 C' 4 /--1 ❑ 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 / i/ / /7 To y l L y l /7 Report Type: D -Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ lo . Expenditures $ / v s� Loans $_ , _ , _ • Transfers to Office Account $ • Total Monetary $_ , _ , /0 Total Monetary $ 0 .r-0 In -Kind $_ _ . y (8) Other Distributions $ v (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 5� IO 5J s, $ �C (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) L5'G,o i! W. (Type name) S"71 G,,. /L4 ,¢%,44 ❑ Individual(only for IE a fmasurer ❑ Deputy HTreasurer didate [I Chairperson (only for PC and PTY) or electioneering comm.) X t^ x GtJ Signature"Signatur DS -DE 12 ( .11/13) SEE REVERSE FOR INSTRUCTIONS Instructions for Campaign Treasurer's Report Summary (1) Name: full name of the candidate, political committee, party executive committee, electioneering communications organization, or individual making an independent expenditure or electioneering communication. (2) Address: the full address or post office box, city, stale, and zip code. -_ Check the box if the address has changed since the last report filed. (3) ID Number: identification number assigned by the filing officer. 4 Check the appropriate box(es). (5) Report Identifiers Cover Period: the dates this report covers (i.e.. From 1/1/15 To 1/31/55). Important: use the appropriate cover period dates as published by the filing officer. Report Type: refer to the filing officer's calendar of reporting dates for the correct codes to be used for each reporting period. If report is for a special election add "S" in front of the report code (i.e., SG3). Check one of the appropriate boxes: Original: first report filed for this reporting period. Amendment: must summarize only contributions/fund transfers and expenditures/distributions being reported as additions or deletions. Read instructions for sequence numbers and amendment types on the back of Forms DS -DE 13A and 14A. Special Election Report: Important: once a special election report is filed, the entity is required to file all remaining reports due for the special election. (6) Contributions This Report: Cash and Checks: total amount for this reporting period. Loans: total amount for this reporting period. Total Monetary: sum of Cash and Checks and Loans. In -Kind: the fair market value of the in-kind contribution at the time it is given for this reporting period. (7) Expenditures This Report: Monetary Expenditures: total amount of monetary expenditures for this reporting period. Transfers to Office Account: total amount transferred to an office account by elected candidates only. Total Monetary: sum of Monetary Expenditures and Transfers to Office Account. (S) Other Distributions: the total amount of goods and services contributed to a candidate or other committee by a PC, ECO, or PTY. (9) TOTAL Monetary Contributions To Date: the amount of total monetary contributions to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (10) TOTAL Monetary Expenditures To Date: the amount of total monetary expenditures to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (11) Type or print the required officer's name and have them sign the report: - Candidate report: treasurer and candidate must sign. - PC report: treasurer and chairperson must sign. PTY report: treasurer and chairperson must sign. - ECO report: organization's treasurer must sign. — IE or EC report: individual must sign (this applies when an individual acts alone to make these expenditures) AMENDMENT REPORTS: An amendment report summary should summarize only contributions, expenditures, distributions, & fund transfers being reported as additions or deletions. Read the instructions for the sequence number & amendment type fields on the back of forms DS -DE 13, 14, 14A and 94. CAMPAIGN TREASURER'S REPORT—ITEMIZED CONTRIBUTIONS (1) Name Gr/' (6) Contributor Type Occupation (2) I.D. Number (11) Amendment (12). Amount (3) Cover Period 2 / ii / /7 through L / Z // / / 7 (4) Page �_ of L (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address& City, State, Zip Code (6) Contributor Type Occupation (9) Contribution Type (10) In-kind Description (11) Amendment (12). Amount (6) Sequence Number Z / i 7/ / ,SCar W. /Ylar wr oce#, 6 rJGGlrAC-A, X 33 3 S o �u l t L/ / /7 //yam AJ. ,cc�zaA4W � �L GS ��A.•a K 33 US -UE 13 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (10) Type the description of any in-kind contribution received. Candidate's Only — If in-kind contribution is from a party executive committee and is allocable toward the contribution limits, type an "A" in this box. If contribution is not allocable, type an "N". (11) Amendment Type (required on amended reports) —To add a new (previously unreported) contribution for the reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data. The sequence number for contributions with amendment type "ADD" will start at one plus the number of contributions in the original report. For example, amending an original M1 report that had 75 contributions means the sequence number of the first contribution having amendment type "ADD" will be 76; the second "ADD" contribution would be 77, etc. When amending an original M2 report that had 40 contributions, the sixth "ADD" contribution would have sequence number 46. To correct a previously submitted contribution use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the contribution to be corrected. In combination with the report number being amended, this sequence number will identify the contribution to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (12) Type amount of contribution received. Political Committees ONLY: Multiple uniform contributions from the same person, aggregating NMT $250 per calendar year, collected by an organization that is the affiliated sponsor of a PC, may be reported by the PC in an aggregate amount listing the number of contributors together with the amount contributed by each and the total amount contributed during the reporting period. The identity of each person making such uniform contribution must be reported to the filing officer by July 1 of each calendar year, or, in a general election year, NLT the 60th day immediately preceding the primary election. CAMPAIGN TREASURER'S REPORT— ITEMIZED EXPENDITURES (1)Name Sto:i /✓ /rta4^ (2)I.D.Number _ (3) Cover Period 2 / // / 17 through 2 12 (4) Page I of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (5) Purpose (add office sought if contribution to a candidate) (g) Expenditure Type (10) Amendment (11) Amount (5) Sequence Number Z 1� ,7 j Vim J1. 6V"1 ,fr C -.a»( . /O� de,, A4 Ws CfnZ.,-. te.Lnhcast�✓ CA / 42M rit Kh C.+�n.ir 2y0 1, 7"Ayzry 724✓ p.q-TR G viF JTrACA- �. ,� � Z DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES To correct a previously submitted expenditure use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the expenditure to be corrected. In combination with the report number being amended, this sequence number will identify the expenditure to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (11) Amount of expenditure. CAMPAIGN TREASURER'S REPORT SUMMARY (1) OFFICE USE ONLY Name (2) N. Address (number and street) l vc�-' s7XC-4'n F <? Y83 City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): O-dandidate Office Sought: mow-, LaZf/�f/sf of 6,'LP. sjvl�=�1 K ❑ 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/ Z S_To l I �- � / � / / �- Report Type: Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ y83 .26- Expenditures $ $�'/ 6- Loans Loans $_ _ , _ Transfers to Office Account $ Total Monetary $_ ,/d',3 . &4• Total Monetary $� In-Kind (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ /,95y . 3G $ ?92, rl (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) Seo (.✓. JVLO I'aG'7 (Type name) 'rkv, '44 a 'L&4^�l ❑ Individual (only for IE usurer ❑ Deputy Treasurer ;�ndidate ❑ Chairperson (only for PC and PTY) or electioneering comm.) X V✓. WL. X Signa re Signatu e I DS -DE 12 (Rev. 11/13) SE'E"REVERSE FOR INSTRUCTIONS r Instructions for Campaign Treasurer's Report Summary (1) Name: full name of the candidate, political committee, party executive committee, electioneering communications organization, or individual making an independent expenditure or electioneering communication. (2) Address: the full address or post office box, city, state, and zip code. - Check the box if the address has changed since the last report filed. (3) ID Number: identification number assigned by the filing officer. 4 Check the appropriate box(es). (5) Report Identifiers Cover Period: the dates this report covers (i.e., From 1/1/15 To 1/31/55). Important: use the appropriate cover period dates as published by the filing officer. Report Type: refer to the filing officer's calendar of reporting dates for the correct codes to be used for each reporting period. If report is for a special election add "S" in front of the report code (i.e., SG3). Check one of the appropriate boxes: Original: first report filed for this reporting period. Amendment: must summarize only contributions/fund transfers and expenditures/distributions being reported as additions or deletions. Read instructions for sequence numbers and amendment types on the back of Forms DS -DE 13A and 14A. Special Election Report: Important: once a special election report is filed, the entity is required to file all remaining reports due for the special election. (6) Contributions This Report: Cash and Checks: total amount for this reporting period. Loans: total amount for this reporting period. Total Monetary: sum of Cash and Checks and Loans. In -Kind: the fair market value of the in-kind contribution at the time it is given for this reporting period. (7) Expenditures This Report: Monetary Expenditures: total amount of monetary expenditures for this reporting period. Transfers to Office Account: total amount transferred to an office account by elected candidates only. Total Monetary: sum of Monetary Expenditures and Transfers to Office Account. (S) Other Distributions: the total amount of goods and services contributed to a candidate or other committee by a PC, ECO, or PTY. (9) TOTAL Monetary Contributions To Date: the amount of total monetary contributions to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (10) TOTAL Monetary Expenditures To Date: the amount of total monetary expenditures to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (11) Type or print the required officer's name and have them sign the report: - Candidate report: treasurer and candidate must sign. PC report: treasurer and chairperson must sign. - PTY report: treasurer and chairperson must sign. = ECO report: organization's treasurer must sign. IE or EC report: individual must sign (this applies when an individual acts alone to make these expenditures) AMENDMENT REPORTS: An amendment report summary should summarize only contributions, expenditures, distributions, & fund transfers being reported as additions or deletions. Read the instructions for the sequence number & amendment type fields on the back of forms DS -DE 13, 14,14A and 94. CAMPAIGN TREASURER'S REPORT– ITEMIZED CONTRIBUTIONS (1) Name 'S.- _• —./ I -V-.26 .-4'1 (2) I.D. Number (3) Cover Period 7/ Z� / / through 3 / C (4) Page % of / (6) Date (7) Full Name (Last, Suffix, First, Middle) Street Address& City, State, Zi Code (8) Contributor Type Occupation— (9) Contribution Type (to) In-kind Descri tion (91> Amendment biz) Amount (6) Sequence Number Z 1 Z S 1/ �l ya AJ --M .4 4 A S S-l7S o.3� 31 / 117 IIY A aCC.4- t,n -'3- 3.3YD 5 S–cv i 2- ;z.Td3 Ilya ll. uc- &a%L.0 fh 4.n '�j 33 y33 S S'C.OJ 1 1 / 1 / 1 u5-ut 13 (Key. 79113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Candidate's full name or name of the political committee (PC), electioneering communications organizations (ECO) or party executive committee (PTY). (2) The identification number assigned by the filing officer. (3) Cover period dates (e.g., 1/1/15 through 1/31/15). (See filing officer's reporting dates calendar for appropriate year and cover periods.) (4) Page numbers (e.g., 1 of 3 ). (5) Date contribution was RECEIVED (Month/Day/Year). (6) Sequence Number — Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer. This method of unique identification is required for responding to requests from the filing officer and for reporting amendments. For example, a M1 report having 75 contributions would use sequence numbers 1 through 75. The next report (M2), comprised of 40 contributions would use sequence numbers 1 through 40. Contributions an amended M1 reports would begin with sequence number 76 and on amended M2 reports would begin with sequence number 41. See the Amendment Type instructions below. (7) Type full name and address of contributor (including city, state and zip code). (8) Enter the type of contributor using one of the following codes: Occupation of contributor for contributions over $100 only. (If a business, please indicate nature of business.) I Individual CAS B Business also includes corporations, organizations, groups, etc. E Electioneering Communications Organizations INK F Political Committee federal or state P Political Parties (includes federal, state and county executive committees O Other (e.g., candidate surplus funds to party, etc. S Candidate to Self REF (9) Enter Contribution Type using one of the following codes: NOTE: Cash Includes cash and cashier's checks. Code Description CAS Cash or Cashier's Check CHE Check COF Carryover Funds from Previous Campaign INK In -Kind INT Interest LOA Loan MO Money Order MUC Multiple Uniform Contributions RCT Other Receipts REF Refund (Negative Amount Only) (10) Type the desdription of any in-kind contribution received. Candidate's Only — If in-kind contribution is from a party executive committee and Is allocable toward the contribution limits, type an "A" in this box. If contribution is not allocable, type an "N". (11) Amendment Type (required on amended reports) — To add a new (previously unreported) contribution for the reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data. The sequence number for contributions with amendment type "ADD" will start at one plus the number of contributions in the original report. For example, amending an original M1 report that had 75 contributions means the sequence number of the first contribution having amendment type "ADD" will be 76; the second "ADD" contribution would be 77, etc. When amending an original M2 report that had 40 contributions, the sixth "ADD" contribution would have sequence number 46. To correct a previously submitted contribution use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the contribution to be corrected. In combination with the report number being amended, this sequence number will Identify the contribution to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (12) Type amount of contribution received. Political Committees ONLY: Multiple uniform contributions from the same person, aggregating NMT $250 per calendar year, collected by an organization that is the affiliated sponsor of a PC, may be reported by the PC in an aggregate amount listing the number of contributors together with the amount contributed by each and the total amount contributed during the reporting period. The identity of each person making such uniform contribution must be reported to the filing officer by July 1 of each calendar year, or, in a general election year, NLT the 60th day immediately preceding the primary election. CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name J;r671- w. Ik p t6A(- l (2) I.D. Number (3) Cover Period 4 / 2Y //— - through 3 / `7 / (4) Page l of / (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (6) Sequence Number Lu.a�t-;�Ir /LirY•a Fc .33Y1 124 /—A o Jr en '41c" e �y)vi.v. y �, sr� Sw S12 l4- JYA&I-1 ry/-e P-4iz, 61/.fizcJwtl),2n. Gan,els C4 -.I �s_t 3 1-!e/en WGr� �e s7u�rt, DS -DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Candidate's full name or name of the political committee (PC), electioneering communications organization (ECO), or party executive committee (PTY). (2) Identification number assigned by the filing officer. (3) Cover period dates (01/01/15 through 01/31/15). (See filing officer's reporting dates calendar for appropriate cover periods.) (4) Page numbers (e.g., 1 of 3). (5) Date of expenditure (Month/DayNear). (6) Sequence Number - Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer. This method of unique identification is required for responding to requests from the filing officer and for reporting requirements. For example, a M1 report having 40 expenditures would use sequence numbers 1 through 40. The next report (102), comprised of 30 expenditures would use sequence numbers 1 through 30. Expenditures on amended M1 reports would begin with sequence number 41 and on amended M2 reports would begin with sequence number 31. See Amendment Type instructions below. (7) Full name and address of entity receiving payment (including city, state and zip code). (8) Purpose of expenditure (if expenditure is a contribution to a candidate, also type the office sought by the candidate). PLEASE NOTE: This column does not apply to candidate expenditures, as candidates cannot contribute to other candidates from campaign funds. However, PCs (supporting candidates) and party executive committees contributing to candidates must report office sought (Section 106.07, F.S.). (9) Enter Expenditure Type using one of the following codes: Code Description CAN Candidate Expense DIS Disposition of Funds DFC Disposition of Funds to Future Campaign effective 11/1/13 DPP Disposition of Funds to Political Part effective 11/1/13 DPV Disposition of Funds to Petition Verification effective 11/1/13 ECC Electioneering Communication IEC Independent Expenditure Regarding a Candidate IEI Independent Expenditure Regarding an Issue MON Moneta Not to a Candidate PCW PettyCash Withdrawn PCS PettyCash Spent PPD Pre -paid Distribution REF Refund (Negative Amount Only) RMB Reimbursements TOA Transfer to Office Account (Disposition of Funds (10) Amendment Type (required on amended reports) - To add a new (previously unreported) expenditure for the reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data. The sequence number for expenditures with amendment type "ADD" will start at one plus the number of expenditures in the original report. For example, amending an original M1 reports that had 75 expenditures, means the sequence number of the first expenditure having amendment type "ADD" will be 76; the second "ADD" expenditure would have sequence number 39. To correct a previously submitted expenditure use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the expenditure to be corrected. In combination with the report number being amended, this sequence number will identify the expenditure to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (11) Amount of expenditure. SUPERVISOR OF ELECTIONS REGISTERED VOTER INFORMATION REPORT ORDER FORM ORDERS }HILL NOT -BE ACCEPTED UNTIL A CHECK (MADE PAYABLE TO THE PALM BEACH COUNTY SUPERVISOR OF ELECTIONS), A DEPOSITOR CASH PAYMENT IS RECEIVED. 'Candidates and Political Committees must submit a check drawn on their campaign or committees' accounts. ORDERS RECEIVED BEFORE 2:00 PM ARE GENERALLY COMPLETED & READY FOR PICKUP AFTER 90:00 AM ON THE FOLLOWING BUSINESS DAY. HOWEVER, TO AVOID UNNECESSARY DELAYS, PLEASE CALL BEFOREPICKuaI NAME OF CANDIDATE, POLITICAL COMMITTEE OR OTHER:�Cu /!terr O 14.4 A) OFFICE CANDIDATE IS SEEKING (if applicable): �.vlitr[13Sio ,dam /G•t J% 6✓c / JTcc NAME OF PERSON PLACING ORDER: ADDRESS, CITY & ZIP:. INO k n rC-A IIJ AIL,D` H,1, r Cy -Ar . _ C z DAYTIME TELEPHONE, NUMBER: SIGNATURE OF PERSON'PICKING UP�ORDER: X USE ONLY ELECTIONS OFFICE DEPUTY TAKING ORDER: TO MAIN OFFICE EMPLOYEE:: DATE & TIME OF ORDER:' / t: S DATE: (Used byNanh. SoutlfAG14es Offices) CHECK WHERE APP ICABLE `•' m ' / D �O C7 'CHECK O CASH IN 7HE AMOUNT OF $. . dcl�O • � _... PAID 'E , ❑ BLANK CHECK BEING HELD AT ,NORTH OFFICE 1 SOUTH OFFICE / MAIN OFFICE /,GLA :_ — / ' . (CIRCLE ONE) CEJ ORDER TO BE PICKED UP AT NORTH OFFICE / SOUTH OFFICEEEH��) GLADES OFFICE ' (CIRCLE ONE) 'Piease note There is a 3 -day delivery when picking up an order from any branch office. `a} INVOICE: _ ©, ?? 4 s� +/ OTHER �(/ 6e— � r e c! Lg—I 90 E cr�J DATA PROCESSING USE ONLY EMPLOYEE RUNNING ORDER: OZ 2-0 7 572DATE / TIME ORDER RECEIVED: L DATE I TIME COMPLETED: RECORD COUNT: Rev: 021ar417 Z (E91 '0N 2, sucq LASHARMOFFICEFORMSWE REPORT FORM.PDF ssau!snq WdBD:ZI MZ bZ p j i 1530 W BOYNTON BEACH BLVD BOYNTON BEACH FL 33436-9998 1109640260 03/01/2017 (600)275-6777 11:06 AN Product== -Ysale Final Description Oty Price 00 Flag Coil/1 _._ q (Unit Prfce:$49.00) Credit Cartl memltd - (Card Name:MasterCard) (Account N:XXXXXXXXXXXX5195) (Approval N:63478P) (Transaction 11:047) tiY;RYtitf tYilYiittttRYYitii;fitttttil cardsTavlaiilableSOMEONE'S for purchase at seOX lect Post Offices. RYSttti; Y..Rii... .t,* YtRY'ttt t; ttf R..Yti In a hurry? Self-service klosks offer Wick and easy check-out. Any Retail Associate can show you h.rw. Order stamps at usps.com/shop or call 1-800-Stamp24. Go to usps.com/cllcknship to pt•Int shipping labels with postage. 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Returns and exchanges will be processed in a timely manner. Please allow two billing cycles for the credit to appear on your statement. 5. Return to: Paper Style Returns Department 11390 Old Roswell Road - Suite 122 Alpharetta, GA 30009 *Shipping charges are non-refundable. All sales are final on Sales Merchandise. MERCHANDISE RETURNED Comments: Your Paper Style Order Number (found on front of this sheet): Reason for Return (please check one): Damaged in transit _ Defective _ Incorrect Quantity Incorrect Merchandise _ Exchange _ Other (please explain below) (In the event of an exchange, shipping charges will be billed as if it were a new order.) *Notice of damaged, inaccurate or missing product required within 5 days of orderrecefpt. We are unable to expedite or replace mis-shipped or damaged merchandise after this point. BOYNTON BEACH 1530 W BOYNTON BEACH BLVD BOYNTON BEACH FL 33436-9998 1109640260 03/03/2017 (800)275-8777 9:07 AM Product Sale Final Description Oty Price US 00 Flag CcI1/1 4._ $196.bb (Unit Price:$49.00) Total _.. __ - _.. __ .. -- $19 -6 -. 00 -- --- ' Credit Card Remitd $196.Ob (Card Name:AMEX) (Account M:XXXXXXXXXXX8012) (Approval N:313003) (Transaction 11:500) BRIGHTEN SOMEONE'S MAILBOX. Greeting cards avaflable for purchase at select Post Offices. In a hurry? Self-service klosks offer quick and easy check-out. Any Retail Associate can show you how. Order stamps at usps.com/shop or call 1-800-Stamp24. Go to usps.com/clicknship to print shipping labels with postage. For other information call 1 -800 -ASK -USPS. XWWXWW%XWXWWWWWWW%%WWW%WWWWWWW%W%%WWWW Get your mail when and where you want It with a secure Post Office Box. Sign up for a box online at usps.com/poboxes. WWWWW%WWWW%%XWWW%WXXXW%X%WXWX%%W%X%%WW All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE Go to: https://postalexperience.com/Pos 840-5327-0110-004-00011-93076-01 or scan this code with Your mobile device: or nAit i-ann-uu�-�a�n STAKES ES 1540 S.W. 8th Street BOYNTON BEACH, FL 33426 (561) 735-4347 SALE 1288926 4 005 69269 1194 03/03/17 09:29 QTY SKU PRICE REWARDS NUMBER 423B011037 ******* Customer Order 2089353701 ******* 355 Documents 1980563 0.229ea 81;3D Your Rewards Price $0.183 -16.34 Questions on Customer Order 2089353701 Call Customer Service at 1-800-35TAPLES **************************************** 1 ENV #10 P&S SECURI 718103107938 26.99 SUBTOTAL 91.95 Standard Tax 7.0000% 6.44 TOTAL 4 $98.39 AMERICAN EXPRESS USD$98.39 Card No.: XXXXXXXXXXX8012 [Cl Chip Read Auth No.: 561003 AID.: A000000025010402 Congratulations! You received special pricing on this purchase because you are a valued Staples Rewards customer. Remember to always use your rewards number to earn rewards and save at Staples! TOTAL ITEMS 356 *Item is currently on promotion. Some coupons are only valid on regular priced items. Please see coupon terms and conditions for details, Staples brand products. Below Budget, Above Expectations. THANK YOU FOR SHOPPING AT STAPLES ! Shop online at www.staples.com Get with 1:4r• Staples Rewards mem a get up to 5% back in rewards and free shipping every day. Exclusions apply, See an associate for full program details or to enroll. STARES 1540 S.W. 8th Street BOYNTON BEACH, FL 33426 (561) 735-4347 SALE 1288926 8-005 69648 1194 03/07/17 11;44 Your Sales Associate was; Minerva M QTY SKU PRICE REWARDS NUMBER 4238011037 ***#** Customer Order 2089466146 $$#$#$# 700 Documents 1980563 0.173ea 121.10 Your Rewards Price $0.138 -24.50 Questions on Customer Order 2089466146 Call Customer Service at 1-800-3STAPLES SUBTOTAL 96.60 Standard Tax 7.0000% 6.76 TOTAL $103.36 AMERICAN EXPRESS USO$103.36 Card No.; XXXXXXXXXXX8012 [C] Chip Read Auth No.; 376007 AID.; A000000025010402 Congratulations! You received special Pricing on this purchase because you are a valued Staples Rewards customer. Remember to always use your rewards number to earn rewards and save at Staples! TOTAL ITEMS 700 Staples brand products. Below Budget. Above Expectations. THANK YOU FOR SHOPPING AT STAPLES ! Shop online at'www.staples.com Get with the program. Staples Rewards members get up to 5% back in rewards and free shipping every day. Exclusions apply, See an associate for full program details or to enroll, iiil1 iiiiiiiiiii�iiiiiiii iii ii4ii�ii0i5iiii CAMPAIGN TREASURER'S REPORT SUMMARY OFFICE USE ONLY Name (Z) //`/_ ,J. o cF�q� Address (number and street) (gJLF ST-X6,4^.L re— City, LCity, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): Candidate Office Sought:/mowy �o,n NiSSfo , mF guf F _0-4((4q ❑ 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 eriod: From 3 / �� l tor? To y / -25-1 oZo/� Report Type: Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $_ v Expenditures $ OZ . Z �� Loans $ Total Monetary $_ • G� I Transfers — Office Account $ . D In -Kind $1 1 . p (9) TOTAL Monetary Contributions To Date $ , /. 2v. 36 Total Monetary $ , / /pL• Z j (8) Other Distributions $ 1 1 U (10) TOTAL Monetary Expenditures To Date $ /. � C/ V. 3(_ (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) S� r% W . /q o -L6 -¢-1 (Type name) Sc o W, 'A4AA 4A.� ❑ Individual (only for IE reasurer ❑ Deputy Treasurer 9�agnndidate ❑ Chairperson (only for PC and PTY) or electioneering comm.) X Signat e DS -DE 12 (Rev. 11/13) 17 ACCKCVCKACrVKJNV 1KUGI1UKA ti Instructions for Campaign Treasurer's Report Summary (1) Name: full name of the candidate, political committee, party executive committee, electioneering communications organization, or individual making an independent expenditure or electioneering communication. (2) Address: the full address or post office box, city, state, and zip code. - Check the box if the address has changed since the last report filed. (3) ID Number: identification number assigned by the filing officer. 4 Check the appropriate box(es). (5) Report Identifiers Cover Period: the dates this report covers (i.e., From 1/1/15 To 1/31/55). Important: use the appropriate cover period dates as published by the filing officer. Report Type: refer to the filing officer's calendar of reporting dates for the correct codes to be used for each reporting period. If report is for a special election add "S" in front of the report code (i.e., SG3). Check one of the appropriate boxes: Original: first report filed for this reporting period. Amendment: must summarize only contributions/fund transfers and expenditures/distributions being reported as additions or deletions. Read instructions for sequence numbers and amendment types on the back of Forms DS -DE 13A and 14A. Special Election Report: Important: once a special election report is filed, the entity is required to file all remaining reports due for the special election. (6) Contributions This Report: Cash and Checks: total amount for this reporting period. Loans: total amount for this reporting period. Total Monetary: sum of Cash and Checks and Loans. In -Kind: the fair market value of the in-kind contribution at the time it is given for this reporting period. (7) Expenditures This Report: Monetary Expenditures: total amount of monetary expenditures for this reporting period. Transfers to Office Account: total amount transferred to an office account by elected candidates only. Total Monetary: sum of Monetary Expenditures and Transfers to Office Account. (8) Other Distributions: the total amount of goods and services contributed to a candidate or other committee by a PC, ECO, or PTY. (9) TOTAL Monetary Contributions To Date: the amount of total monetary contributions to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (10) TOTAL Monetary Expenditures To Date: the amount of total monetary expenditures to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (11) Type or print the required officer's name and have them sign the report: - Candidate report: treasurer and candidate must sign. - PC report: treasurer and chairperson must sign. PTY report: treasurer and chairperson must sign. - ECO report: organization's treasurer must sign. - IE or EC report: individual must sign (this applies when an individual acts alone to make these expenditures) AMENDMENT REPORTS: An amendment report summary should summarize only contributions, expenditures, distributions, & fund transfers being reported as additions or deletions. Read the instructions for the sequence number & amendment type fields on the back of forms DS -DE 13, 14, 14A and 94. CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS (1) Name S & a 7�L W. o Q p 4 iv (2) I.D. Number (3) Cover Period _3 / / D / 20112 through _ '�_ / 2C / gip/ 51 (4) Page _ L of _L (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (6) Contributor Type Occupation_ (9) Contribution Type (10) In-kind Description (11) Amendment (12) Amount (6) Sequence Number D r / ub-ut i3 tKev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT—ITEMIZED EXPENDITURES (1) Name St'iT W. ,tit�•w.4- / (2) I.D. Number (3) Cover Period 2 / /0 /.2D /+through �_/ ?S-/ la/ -7 (4) Page of / (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (5) Sequence /Number CCCity, t,/ lqj -Lc- 4-1 ocrA^ 61...0- 6'44 T Mi,z 33YX3 J DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Candidate's full name or name of the political committee (PC), electioneering communications organization (ECO), or party executive committee (PTY). (2) Identification number assigned by the filing officer. (3) Cover period dates (01/01/15 through 01/31/15). (See filing officer's reporting dates calendar for appropriate cover periods.) (4) Page numbers (e.g., 1 of 3). (5) Date of expenditure (Month/Day/Year). (6) Sequence Number - Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer. This method of unique identification is required for responding to requests from the filing officer and for reporting requirements. For example, a M1 report having 40 expenditures would use sequence numbers 1 through 40. The next report (M2), comprised of 30 expenditures would use sequence numbers 1 through 30. Expenditures on amended M1 reports would begin with sequence number 41 and on amended M2 reports would begin with sequence number 31. See Amendment Type instructions below. (7) Full name and address of entity receiving payment (including city, state and zip code). (8) Purpose of expenditure (if expenditure is a contribution to a candidate, also type the office sought by the candidate). PLEASE NOTE: This column does not apply to candidate expenditures, as candidates cannot contribute to other candidates from campaign funds. However, PCs (supporting candidates) and party executive committees contributing to candidates must report office sought (Section 106.07, F.S.). (9) Enter Expenditure Type using one of the following codes: Code Description CAN Candidate Expense DIS Disposition of Funds DFC Disposition of Funds to Future Campaign effective 11/1/13 DPP Disposition of Funds to Political Parteffective 11/1/13 DPV Disposition of Funds to Petition Verification effective 11/1/13 ECC Electioneering Communication IEC Independent Expenditure Regarding a Candidate IEI Independent Expenditure Regarding an Issue MON Moneta Not to a Candidate PCW PettyCash Withdrawn PCS PettyCash Spent PPD Pre -paid Distribution REF Refund (Negative Amount Only) RMB Reimbursements TOA Transfer to Office Account (Disposition of Funds (10) Amendment Type (required on amended reports) - To add a new (previously unreported) expenditure for the reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data. The sequence number for expenditures with amendment type "ADD" will start at one plus the number of expenditures in the original report. For example, amending an original M1 reports that had 75 expenditures, means the sequence number of the first expenditure having amendment type "ADD" will be 76; the second "ADD" expenditure would have sequence number 39.