HomeMy Public PortalAboutCampaign Treasurer's Report (3)C MP N TREASURER'S REPORT
(1) e..„4„ - l �f .
SUMMARY
OFFICE USE ONLY
-_.._.. w _ : =E .._.
Name
(2) 13 00/27/1207 66-- — /ir 3/7
A 4 re (numper an st eet)
City, State, Zip Code
❑ Check here if address has changed (3)
U/&4(4) Check ppropriate box(es):idate Office Sought: 0/ GC
ID Number:
/ 6,,,,,,,:s-5,4‘1,74,-- T
❑ 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 ll
Cover Period: From / 0 1' / / To ep / 30 / /, Report Type: kli
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ , 0 . Op
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , , D 00
Loans $ 5_0. 00
to
$ , , D . 0 O
Total Monetary $ 50° • U
$ , , 0 .0 0
!�
In -Kind $ n , V . OV
(8)
Other Distributions !�
$ J • a
(9) TOTAL Moneta Contributions To Date
$ ,' 0 .00
(10)
TOTAL Monetary Expe iture o to
$ . �
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report a it is true, correct,
(Type name) 1//nd ll ` EY / , ru
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) �r / K7
II Individual (only for IE El Treasurer ❑ Deputy Treasurer
andidat Chai (only for PC and PTY)
•
X
or electioneers comm.)
X
Signature
Signature
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN REA URER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name *ax /aro (2) I.D. Number
(3) Cover Period / U/ / /5. through / 3v / /5 (4) Page
of
l
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
/ /d / /S
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0/.S COm/17*nucr"'
,ter 3/ 7
Or/@'% 16 32V2
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05 -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES