HomeMy Public PortalAboutCampaign Treasurer's Report (6)CAMPAIGN TREASURER'S REPORT
(1) J, A re e/ /mil . /1
SUMMARY
::
OFFICE USE ONLY
V3, I_', p
(2)
/d r s (nymber and street)_
n 1/ FY Jo't'I
City, State, Zip Code
❑ Check here if address has changed (3)
(4) Chec ppropriate box(es):
Candidate Office Sought:
ID Number:
❑ 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 /t9 I ,,2/ I /7 To // / I /7 Report Type: C/
Nina! ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ , / ,j S O • OU
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , , 6.5y-. 7f
Loans $ , •
to
$ .
Total Monetary $ , / , /dd • (%)
$ 66Y . 7
In -Kind $ , M • M,
(8)
Other Distributions
$ •
(9) TOTAL Monetary Contributions To Date
$ , g , 7-5Y . SiZ
(10)
TOTAL Monetary Expenditures To Date
$ , 7 , /.)5 . .26.
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) OP / 4l i
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) t� , t2r -e,( R. i
• Individual (only or IE geTre7s.urer In Deputy Treasurer
andidate
X
• Chairperson (only for PC and PTY)
or electioneerin mm.)
X ` " ' <
Sign ur
Signat
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name
�Jt1ree! R. 4-t,
(3) Cover Period /9 I 2/ I /7
(2) I.D. Number
through // / Z_ / /7 (4) Page
1
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(6)
Occupation
(9)
Contribution
Type
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
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DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name J ibreel
(2) I.D. Number
(3) Cover Period /0 l 2/ I /7 through /1 / 02 / /7 (4) Page 2- of
(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
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DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN EA URER'S REPORT - ITEMIZED EXPENDITURES
(1) Name ' /:, (2) LD. Number
(4) Page /
(3) Cover Period /6; / E///7 through /7 / `Z. / //
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)
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(11)
Amount
(6)
Sequence
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DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
- M P A I A R S U R E R ' S R E P O R T - I T E M I Z E D E X P E N D I T U R E S
�� ( 1 ) N a m e J J Q Q r e e / / ( 2 ) I . D . N u m b e r
( 3 ) C o v e r P e r i o d / 1 2 / 2 / / / 7 t h r o u g h / 1 / 2 / / 1
( 4 ) P a g e 2 o f Z .
( 5 )
D a t e
( 7 )
F u l l N a m e
( L a s t , S u f f i x , F i r s t , M i d d l e )
S t r e e t A d d r e s s &
C i t y , S t a t e , Z i p C o d e
( 6 )
P u r p o s e
( a d d o f f i c e s o u g h t i f
c o n t r i b u t i o n t o a
c a n d i d a t e )
( 9 )
E x p e n d i t u r e
T y p e
( 1 0 )
A m e n d m e n t
( 1 1 )
A m o u n t
( 6 )
S e q u e n c e
N u m b e r
a / 9 2 / 7 7
? Y
F a -
i . 7 6 - 5
0 7
/ /
/ /
/ /
/ /
/ /
/ /
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D S - D E 1 4 ( R e v . 1 1 / 1 3 )
S E E R E V E R S E F O R I N S T R U C T I O N S A N D C O D E V A L U E S