HomeMy Public PortalAboutCampaign Treasurer's Report (M-6)CAMPAIGN TREASURER'S REPORT SUMMARY
(1) OFFICE USE ONLY
Name
(2)
Address (number and street)
City, State, Zip Code
Check here if address has changed (3)ID Number:
(4)Check appropriate box(es):
Candidate Office Sought:
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 / / To / / Report Type:
Original Amendment Special Election Report
(6)Contributions This Report (7)Expenditures This Report
Monetary
Expenditures Cash & Checks $ , , . $ , , .
Loans $ , , . Transfers to
Office Account $ , , .
Total Monetary $ , , .
Total Monetary $ , , .
In-Kind $ , , .
(8)Other Distributions
$ ,, .
(9)TOTAL Monetary Contributions To Date (10)TOTAL Monetary Expenditures To Date
$ , , .$ , , .
(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) (Type name)
Individual (only for IE Treasurer Deputy Treasurer Candidate Chairperson (only for PC and PTY)
or electioneering comm.)
X X
Signature Signature
DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
By City Clerk
Nicolette Fariello Springer
1217 Reading Drive
Orlando, FL 32804
2021D3004
4 District 3, Orlando City Commissioner
M-6/1-6/30
4
4
22 937 97
0 00
22 937 97
210 79
1 810 41
0 00
1 810 41
22 937 97
0 00
1 810 41
06 01 21 06 30 21
95D1D872-E0F2-45CB-A3C9-2A27DC8B12CC
07/12/21 - 04:27:25
07/12/21 - 04:27:25
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 206 15
06 Laurie Wack
Individual
Retired Check
$100.001
Individual
Retired Check
$100.002
Individual
Attorney Check
$100.003
Individual
Retired Check
$300.004
Individual
Retired Check
$100.005
Individual
Operations
Manager
Check
$500.006
Individual
Retired Check
$51.837
01 21 30 21
22 21
06 30 21
06 22 21
06 30 21
06 23 21
06 28 21
06 29 21
710 Fairoaks Ln
Maitland, FL 32751
Adrienne Katz
1324 Serena Dr
Winter Park, FL 32789
Denise Hammond
2115 Lakeside Dr
Orlando, FL 32803
Joan Erwin
116 Fernwood Street
Orlando, FL 32806
Enrique De La Torre
200 E Lake Sue Ave
Winter Park, FL 32789
Mary Dipboye
938 Golfside Dr
Winter Park, FL 32792
1940 Summerland Ave
Winter Park, FL 32789
Karolyn Sue Foreman
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 306 15
06 Jeremy Dorsett
Individual
Consultant Check
$500.008
Individual
Mental
Health Assn.
CEO
Check
$100.009
Individual
Retired Check
$516.4510
Individual
Property
Appraiser
Check
$100.0011
Individual
Retired Check
$1,000.0012
Individual
Mayor of
Winter Park
Check
$1,000.0013
Individual
Retired Check
$100.0014
01 21 30 21
17 21
06 07 21
06 30 21
06 30 21
06 09 21
06 11 21
06 15 21
1409 Chapman Cir
Winter Park, FL 32789
Marni Berger Stahlman
PO Box 328
Winter Park, FL 32790
Bickley Wilson
1100 S Orlando Ave Apt
878
Maitland, FL 32751
Amy Mercado
12349 Turtle Grass Dr
Orlando, FL 32824
Phillip Anderson
1621 Roundelay Ln
Winter Park, FL 32789
Todd Weaver
1051 Lake Bell Dr
Winter Park, FL 32789
1508 Lake Shore Dr
Orlando, FL 32803
Brian Anderson
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 406 15
06 Roger Weeden
Individual
Attorney Check
$500.0015
Individual
Retired Check
$26.0116
Individual
Retired Check
$51.8317
Individual
Attorney Check
$100.0018
Individual
Author Check
$103.4519
Individual
Attorney Check
$100.0020
Individual
Climate
Organizer
Check
$20.0021
01 21 30 21
29 21
06 30 21
06 23 21
06 21 21
06 24 21
06 18 21
06 30 21
650 E Robinson St
Orlando, FL 32801
Susan Windmiller
17617 Woodfield Hill Ct
Orlando, FL 32820
Carmen Torres
12159 Homestead Park
Ln
Orlando, FL 32824
Charles Steinberg
1287 Harmon Ave
Winter Park, FL 32789
Asima Azam
4317 New Broad St
Orlando, FL 32814
Mary Linn
"804 Rugby St, Unit 1"
Orlando, FL 32804
719 Terra Pl
Maitland, FL 32751
Gloria Pickar
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 506 15
06 Stuart L Douglas
Individual
"Vice
President,
Business
Initiatives
Consultant"
Check
$250.0022
Individual
Small
Business
Owner -
Trucking
Check
$500.0023
Individual
Retired Check
$100.0024
Individual
CEO
Elevation
Financial
Group
Check
$1,000.0025
Individual
Check
$26.0126
Individual
Motivational
Speaker
Check
$258.3227
Individual
Check
$50.0028
01 21 30 21
13 21
06 12 21
06 07 21
06 17 21
06 23 21
06 26 21
06 25 21
919 Golfview St
Orlando, FL 32804
Frances Fariello
2328 Baja Trl
Ormond Beach, FL
32174
Douglas Lee Camarigg
1204 Reading Dr
Orlando, FL 32804
Thomas Christopher
King
1802 Stonehurst Rd
Winter Park, FL 32789
Sally Hogshead
4551 New Broad St
Orlando, FL 32814
Val C Mobley
226 W King St
Orlando, FL 32804
777 N Orange Ave Apt
704
Orlando, FL 32801
Regina Sheridan
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 606 15
06 Janice O'Rourke
Individual
Retired Check
$100.0029
Individual
Attorney Check
$1,000.0030
Individual
Self-
employed
Check
$1,000.0032
Individual
Retired Check
$200.0033
Individual
Retired Check
$200.0034
Individual
Attorney Check
$500.0035
Individual
Check
$27.0036
01 21 30 21
22 21
06 30 21
06 30 21
06 21 21
06 28 21
06 21 21
06 18 21
11211 Lake Louisa Rd
Clermont, FL 34711
Alexander Weeden
1625 E Ridgewood St
Orlando, FL 32803
Harold Mills
11900 Lake Butler Blvd
Windermere, FL 34786
Cynthia Mackinnon
875 Old England Ave
Winter Park, FL 32789
Maura Smith
901 Georgia Ave
Winter Park, FL 32789
Adam Woodhall
2223 Black Mangrove Dr
Orlando, FL 32828
PO Box 770973
Steamboat Springs, CO
80477
Deirdre Macnab
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 706 15
06 Brendan Ramirez
Individual
Behavioral
Health CEO
Check
$250.0037
Individual
Retired Check
$500.0038
Individual
Retired Check
$1,000.0039
Individual
CEO of
Wendover
Housing
Partners
Check
$1,000.0040
Individual
Business
Developmen
t
Check
$250.0041
Individual
Director of
Communicat
ions
Check
$500.0042
Individual
Retired Check
$250.0043
01 21 30 21
29 21
06 29 21
06 11 21
06 25 21
06 28 21
06 29 21
06 30 21
1606 Lady Slipper Cir
Orlando, FL 32825
Janet Hommel
258 W Lyman Ave
Winter Park, FL 32789
Jennifer Anderson
1621 Roundelay Ln
Winter Park, FL 32789
Jonathan Wolf
149 Harston Ct
Heathrow, FL 32746
Valerie Anderson
1415 Pacifica Dr Apt 402
Kissimmee, FL 34744
Nancy C Jacobson
1730 Reppard Rd
Orlando, FL 32803
8326 Laureate Blvd
Orlando, FL 32827
Tom Keen
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 806 15
06 Homer Hartage
Individual
President
Elder Care
Check
$100.0044
Individual
Check
$50.0045
Individual
Attorney Check
$100.0046
Individual
Political
Director
Check
$100.0047
Individual
Loan
Originator
Check
$258.3249
Individual
Retired Check
$500.0050
Individual
Banker Check
$250.0051
01 21 30 21
30 21
06 30 21
06 30 21
06 30 21
06 28 21
06 16 21
06 25 21
4862 Indialantic Dr
Orlando, FL 32808
Eugene Stoccardo
381 Roswell Ave
Orlando, FL 32803
Sheila Deciccio
1603 Laurel Park Rd
Winter Park, FL 32789
Tim Wagner
17705 N Juday Lake Dr
South Bend, IN 46635
Tom Cook
"490 E Colonial Dr, Unit
519"
Orlando, FL 32803
Ken LaRoe
22449 Lake Seneca Rd
Eustis, FL 32736
124 N Summerlin Ave
Sanford, FL 32771
Brandy Robinson
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 906 15
06 Sarah Lis
Individual
Attorney Check
$150.0052
Individual
Retired Check
$20.8553
Individual
Technology
Director
Check
$103.4554
Individual
Educational
Director
Check
$300.0055
Individual
Bartender Check
$103.4556
Individual
Check
$33.0057
Individual
Director of
Corporate
Social
Responsibilit
y
Check
$50.0058
01 21 30 21
29 21
06 29 21
06 29 21
06 30 21
06 15 21
06 29 21
06 30 21
633 N Victoria Park Rd
Fort Lauderdale, FL
33304
Carol Foglesong
"2789 Lake Baldwin
Blvd, Unit C303"
Orlando, FL 32814
Ronald Bilbao
1500 Bay Blvd
Miami Beach, FL 33139
Rachel Chipman Allen
1865 Derbyshire Rd
Maitland, FL 32751
Michelle Martin
1425 Ferris Ave
Orlando, FL 32803
Ilina Ewen
304 E Park Dr
Raleigh, NC 27605
505 Glenview Dr
Oxford, OH 45056
Daniel Otto
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 1006 15
06 Aaron Powell
Individual
Educator Check
$100.0059
Individual
Student Check
$10.0060
Individual
School
Board
Member
Check
$100.0061
Individual
Program
Specialist
Check
$25.0062
Individual
Attorney Check
$100.0063
Individual
Non-profit
Director
Check
$150.0064
Individual
Consultant Check
$100.0065
01 21 30 21
16 21
06 14 21
06 14 21
06 11 21
06 11 21
06 11 21
06 10 21
804 Vassar Street
Orlando, FL 32804
Kira Diehl
1881 Shiloh Lane
Winter Park, FL 32789
Angie Gallo
14842 Bonnybridge
Drive
Orlando, FL 32826
Elizabeth Lashley
Rothwell
1418 Georgia Blvd
Orlando, FL 32803
Alex Barrio
5910 Alderfer Springs
Drive
Jacksonville, FL 32258
Eileen Winterble
8360 Lindahl Alley
Orlando, FL 32827
1809 Wingfield drive
Longwood, FL 32779
Patricia Sigman
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 1106 15
06 Emma Collum
Individual
Attorney Check
$100.0066
Individual
Self-
employed
Check
$50.0067
Individual
Nurse Check
$25.0068
Individual
Copy Editor Check
$10.0069
Individual
Self-
employed
Check
$100.0070
Individual
Consultant Check
$500.0071
Individual
Consultant Check
$100.0072
01 21 30 21
10 21
06 10 21
06 10 21
06 10 21
06 09 21
06 09 21
06 09 21
1640 E Sunrise Blvd
Fort Lauderdale, FL
33304
Lisa Davis
5 Veritas Way
Barrington, RI 02806
Melody Butler
235 East Shore Road
Lindenhurst, NY 11757
Paula Kiger
4263 Raleigh Way
Tallahassee, FL 32311
Marcello Fischer
8530 Milano Drive
Orlando, FL 32810
Lindsay Pollard
5204 NW 67th Ave
Lauderhill, FL 33319
PO Box 544
Sanford, FL 32772
Pasha Baker
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 1206 15
06 Austin Valle
Individual
Business
Developmen
t Manager
Check
$100.0073
Individual
Executive
Director -
GLPA LEAD
Check
$33.0074
Individual
Professor Check
$100.0075
Individual
Director of
Public
Affairs -
Elevation
Financial
Check
$100.0076
Individual
Creative
Director
Check
$100.0077
Individual
Realtor Check
$200.0078
Individual
Attorney Check
$500.0079
01 21 30 21
09 21
06 09 21
06 09 21
06 09 21
06 09 21
06 09 21
06 09 21
2918 Carroll Place
Orlando, FL 32804
Alexis Hart
3891 South Rosebud
Drive Southeast
Kentwood, MI 49512
Raleigh Blasdell
258 Charleston Avenue
Romeoville, IL 60446
Benjamin Friedman
630 Renaissance Pointe
Altamonte Springs, FL
32714
Matt Matin
14265 Sunridge
Boulevard
Winter Garden, FL
34787Deborah Barra
9142 San Ambrosio Dr.
Orlando, FL 32836
11 Westchester Dr
Kissimmee, FL 34744
Heather Kahoun
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 1306 15
06 Tracey Kagan
Individual
Attorney Check
$100.0080
Individual
Finance
Director
Check
$100.0081
Individual
Attorney Check
$500.0082
Individual
Consultant Check
$10.0083
Individual
Small
business
owner -
Construction
Check
$100.0084
Individual
Video Game
Designer
Check
$150.0085
Individual
Small
business
owner -
trucker
InKind Food for
event
$107.0886
01 21 30 21
09 21
06 09 21
06 09 21
06 08 21
06 30 21
06 29 21
06 07 21
112 Woodmill Road
Longwood, FL 32779
Jonathan Stewart
2048 29th Avenue North
St. Petersburg, FL 33713
Charles O'Neal
2329 Park Village Place
Apopka, FL 32712
Nicolette Springer
1217 Reading Dr
Orlando, FL 32804
Anthony Fariello
10180 104 St NW
Edmonton, AB T5J1A
Frances Fariello
2328 Baja Trl
Ormond Beach, FL
32174
450 Ventris Ln
Maitland, FL 32751
Karen Estrin
CAMPAIGN TREASURER’S REPORT – ITEMIZED CONTRIBUTIONS
(1) Name (2)I.D. Number
(3)Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Nicolette Fariello Springer 2021D3004
06 1406 15
06 Michael Fariello Jr
Individual
Marketing
Manager
Check
$700.0087
Individual
Retired Check
$100.0088
Business
Union Check
$1,000.0089
Individual
Poltical
Consultant
Check
$500.0090
Individual
Retired Check
$25.0091
Individual
Realtor Check
$500.0092
Individual
Retired InKind Food for
event
$103.7193
01 21 30 21
20 21
06 07 21
06 23 21
06 16 21
06 30 21
06 07 21
06 30 21
801 Dexter Ave N #701
Seattle, WA 98109
Martha Haynie
1700 Nela Ave
Belle Isle, FL 32809
International Union of
Painters and Allied
Trades District Council
782153 W Oak Ridge Road
Orlando, FL 32809
Jackie Lee
5750 Parkview Lake Dr
Orlando, FL 32821
Eric Rollings
139 E Muriel St
Orlando, FL 32806
Susan Windmiller
17617 Woodfield Hill Ct
Orlando, FL 32820
4415 Gatlin Grove Dr
Orlando, FL 32812
Ann Patton
CAMPAIGN TREASURER’S REPORT – ITEMIZED EXPENDITURES
DS-DE 14 (Rev. 11/13)
(1)Name ______________________________________________________
(3) Cover Period ______/______/______ through ______/______/______
(2) I.D. Number _____________________
(4) Page ____________ of _____________
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(5)
Date Purpose
(add office sought if
contribution to a
candidate) Amount
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Expenditure
Type Amendment
(6)
Sequence
Number
(7) (8) (9) (10) (11)
Nicolette Fariello Springer 2021D3004
06 01 21 06 30 21 15 15
06 30 21 Stripe Monetary
Add $105.34
1 510 Townsend St
San Francisco, CA 94103
Shelbie Press Print & Copy
06 20 21 Monetary
Add $1,705.07
2
1203 N Mills Ave
Orlando, FL 32803
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.
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 on
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
B Business (also includes corporations, organizations, groups, etc.)
E Electioneering Communications Organizations
F Political Committee (federal or state)
(includes federal, state and county executive P Political Parties committees)
O Other (e.g., candidate surplus funds to party, etc.)
S Candidate to Self
(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)Typ e 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.
INSTRUCTIONS FOR CAMPAIGN TREASURER’S REPORT – FUND TRANSFERS
(1)Type candidate’s full name or name of the political committee (PC), electioneering communications
organization (ECO), or party executive committee (PTY).
(2)Type identification number assigned by the filing officer.
(3)Type cover period dates (e.g., 1/1/15 through 1/31/15). (See filing officer’s reporting dates calendar
for appropriate cover periods.)
(4)Type page numbers (e.g., 1 of 3).
(5)Type date of fund transfer (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 2 fund transfers would use sequence numbers 1 thru 2. The next report (M2),
comprised of 4 fund transfers would use sequence numbers 1 thru 4. Fund transfers on amended M1 reports
would begin with sequence number 3 and on amended M2 reports would begin with sequence number 5. See the
Amendment Type instructions below.
(7)Type full name and address of financial institution (including city, state and zip code).
(8)Enter Transfer Type using one of the following codes:
DESCRIPTION
Transfer FROM identified account to campaign account
Transfer TO identified account from the campaign account
CODE
F
T
(9)Nature of Account (e.g., certificate of deposit, money market, etc...)
(10)Amendment Type (required on amended reports) - To add a new (previously unreported) fund transfer for
the reporting period being amended, enter “ADD” in amendment type on a line with ALL of the required data.
The sequence number for fund transfers with amendment type “ADD” will start at one plus the number of fund
transfers in the original report. For example, amending an original M1 report that had 75 fund transfers, means
the sequence number of the first fund transfer having amendment type “ADD” will be 76; the second “ADD” fund
transfer would be 77, etc. When amending an original M2 report that had 40 fund transfers, the sixth “ADD” fund
transfer would have sequence number 46.
To correct a previously submitted fund transfer use the following drop/add procedure. Enter “DEL” in
amendment type on a line with the sequence number of the fund transfer to be corrected. In combination with
the report number being amended, this sequence number will identify the fund transfer 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)Type amount of fund transfer.
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 Party (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 Monetary (Not to a Candidate)
PCW Petty Cash Withdrawn
PCS Petty Cash 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.
CAMPAIGN TREASURER'S REPORT - ITEMIZED DISTRIBUTIONS
THIS FORM IS USED TO REPORT DISTRIBUTIONS OF GOODS OR SERVICES CONTRIBUTED TO A CANDIDATE
OR COMMITTEE, INDIRECT EXPENDITURES AND REIMBURSEMENTS.
(1)Name of the entity.
(2)Identification number assigned by the filing officer.
(3)Cover period dates (e.g., 03/01/14 through 03/31/14). (See the filing officer’s reporting dates calendar for
appropriate cover periods.)
(4)Page numbers (e.g., 1 of 3).
(5)Date of distribution (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 40 distributions would use sequence numbers 1 through 40. The next report
(M2), comprised of 30 distributions would use sequence numbers 1 through 30. Distributions 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 distribution (including city, state and zip code).
(8)Purpose of distribution (if distribution is a contribution to a candidate, also type the office sought by the candidate).
(9)For each distribution that is related to an itemized expenditure previously listed on Itemized Expenditures (Form
DS-DE 14), enter the Year, Report Type and Sequence Number associated with the expenditure.
*PARTY EXECUTIVE COMMITTEES ONLY - If distribution is allocable toward the contribution limits, type
an "A" in this box. If distribution is nonallocable, type and "N".
(10)Amendment Type (required on amended reports) - To add a new (previously unreported) distribution for the
reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data.
The sequence number for distributions with amendment type "ADD" will start at one plus the number of
distributions in the original report. For example, amending and original M1 report that had 75 distributions, means
the sequence number of the first distribution having amendment type "ADD" will be 76; the second "ADD"
distribution would be 77, etc. When amending an original M2 report that had 30 distributions, the ninth "ADD"
distribution would have sequence number 39.
To correct a previously submitted distribution use the following drop/add procedure. Enter "DEL" in amendment
type on a line with the sequence number of the distribution to be corrected. In combination with the report number
being amended, this sequence number will identify the distribution 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. Assigns the sequence number as described above.
(11)Amount of distribution.
(12)Distribution Type
Code Description
PPD Pre-paid Distribution
RMB Reimbursements
CCP Credit Card Purchase
INK In-Kind Distribution