HomeMy Public PortalAboutCampaign Treasurer's Report (12)CAMPAIGN TREASURER'S REPORT SUMMARY
(1) `Jj brp..1 rR, Pr\.
OFFICE USE ONLY
(2) N D:ex 55I.S/
Ib F_u:tr
ress (number
aIat\elo,
and street) s , f
Ft-- 3agDS
2:5-s
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Che appropriate box(es): A,
Candidate Office Sought: l.. 00)155; On 4 r- --- VI S�-{':
a J6-
❑ 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 I i I j 7 To / I 3 / / /7 Report Type: 44
❑ Original Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ 2.3d.
(7) Expenditures This Report
Monetary
Expenditures $ ,
Loans $ -
Transfers to
Office Account $ ,
Total Monetary $ , , a. 30. oa
Total Monetary $
In -Kind $ , sZ . Oa
(8) Other Distributions
$ , ,
(9) TOTAL Monetary Contributions To Date
$ , ,3 . OD
(10) TOTAL Monetary Expenditures To Date
$ , , 1 .9.8
(11) Certification
It is a first degree isdemeanor for any person
I certify that I have d this repo nd it ' r , correct,
i
(Type name) a -
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) _ )T .? ee.\ `i
■ Individu (onl or IE reasurer ❑ Deputy Treasurer
or electioneers com
X u C�C r
andidate ■ Chairperson (only for PC and PTY)
X .>atz—>
Si natu
./!l/
Sigp re
DS -D 2 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name d rte/ .--4.? 41,/,
(3) Cover Period // / / /7 through
(2) I.D. Number
/ 13/ / / % (4) Page / 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