HomeMy Public PortalAboutCampaign Treasurer's ReportCA AIGN TREASURER'S REPORT
SUMMARY
OFFICE USE ONLY
, s ,_
Name
(2) .:9/Se'ofir e./— ' '3/7
A s9(nu v er an c� street)
a
City, State, Zip Code
❑ Check here if address has changed (3)
(4) Check appropriate box(es):
c
andidate Office Sought: 6/17" 6-57.0.1 e-''
ID Number:
A S/-
2
❑ 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 Ide tifiers
Cover Period: From V / / / /5- To / ,3Z) / /5 Report Type: /1-r V
Election Report
■ Original ❑ Amendment ❑ Special
(6) Contributions This Report
Cash & Checks $ , , 0 . DV Expenditures
(7) Expenditures
Monetary
$
Transfers to
Office Account $
Total Monetary $
This Report
f� x
, (,/ , t�6
Loans $ , 0 O O
, , V v
, DO
Total Monetary $ 0
0 OD
,
In -Kind $ , , 0 0
(8) Other
$
Distributions
,
(9) TOTAL Monetary Contri utionss T� Date
(10) TOTAL
Monetary Expet�c�itures y8ate
(11) Certification
It is a first degree misdemeanor for any person
certify that I have examined this report and it is true, correct,
(Type name) 0M U1`I AL
Ji1n
to falsify a public
and complete:
(Type name) Max
record (ss. 839.13, F.S.)
A'R1014- 4: -
ID Individual (only for IE 0 Treasurer 0 Deputy Treasurer
or electioneering comm.)
X
0 Candidat
X
0 hairperson (only for PC and PTY)
Signature
ure
Signa
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS