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HomeMy Public PortalAboutCampaign Treasurer's Report (G-1)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 Jim (Qualified) Gray 9798 Blandford Rd Orlando, FL 32827 2021D1001 4 District 1, Orlando City Commissioner M- 4 4 18 920 00 0 00 18 920 00 2 001 63 1 813 30 0 00 1 813 30 39 745 00 0 00 2 003 40 09 01 21 09 30 21 FAE00A69-6A33-41C8-883E-372C86025D38 10/07/21 - 08:55:57 10/07/21 - 08:55:57 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 Jim (Qualified) Gray 2021D1001 09 209 7 09 Skyline advisors Business Consultant Check $500.001 Business Property Mgmt Check $1,000.002 Business Investor Check $1,000.003 Business Invstmt banking Check $1,000.004 Business school Check $500.005 Business R/E investor Check $500.006 Business Contractor Check $1,000.007 01 21 30 21 17 21 09 17 21 09 17 21 09 17 21 09 22 21 09 22 21 09 17 21 P.O. Box 560156 Orlando, FL 32856 Westside Property Management LLC 701 Brickell Ave,Suite1550 Miami, FL 33131 Lake Orlando Land Owner, LLC 701 Brickell Ave, Suite 1550 Miami, FL 33131 Westside Capital, LLC 701 Brickell Ave, Suite 1550 Miami, FL 33131 Vision Development and Management 3662 Avalon Park E. Blvd, Suite 201 Orlando, FL 32828 Blue Ox Enterprises,LLC 500 North Way Sanford, FL 32773 3662 Avalon Park E. Blvd, Suite 201 Orlando, FL 32828 Central Florida Championship Karate, Inc 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 Jim (Qualified) Gray 2021D1001 09 309 7 09 John M Hall Company Business Contractor Check $1,000.008 Business Contractor Check $1,000.009 Business r/e developer Check $1,000.0010 Business Contractor Check $1,000.0011 Business r/e developer Check $1,000.0012 Business r/e developer Check $1,000.0013 Business Contractor Check $1,000.0014 01 21 30 21 17 21 09 17 21 09 17 21 09 17 21 09 17 21 09 17 21 09 17 21 1400 Martin Luther King Jr. Blvd Sanford, FL 32771 Ground Preserve Landscape Contractors LLC 3400 South Orange Blossom Trail, Suite B Orlando, FL 32839 Primo Development 12233 Tillinghast CIrcle Palm Beach Gardens, FL 33418 JK2 Costruction PO Box1270 Zellwood, FL 32798 Beachline North Residential, LLC 12233 Tillinghast CIrcle Palm Beach Gardens, FL 33418 Atlantic Pipe Services, LLC 1420 Martin Luther King Jr. Blvd Sanford, FL 32771 3663 Upper Union Road Orlando, FL 32814 Loma Endeavors, Inc 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 Jim (Qualified) Gray 2021D1001 09 409 7 09 GOBA PAC PoliticalCommittee PAC Check $1,000.0015 Individual Investor Check $1,000.0016 Individual Investor Check $1,000.0017 Individual Investor Check $1,000.0018 Individual Attorney Check $500.0019 Business law firm Check $1,000.0020 Individual Business Mgmt Check $20.0021 01 21 30 21 27 21 09 30 21 09 22 21 09 16 21 09 20 21 09 27 21 09 30 21 1953 Clayton Heritage Way Maitland, FL 32751 Shawn and Lorrayne Barrow 4916 Oak Island Road Orlando, FL 32809 Tommy Lee II 1000 Winderley Place #234 Maitland, FL 32751 Richard Lee PO Box 2113 Orlando, FL 32802 Baker & Hostetler 200 South Orange Ave, Suite 2300 Orlando, FL 32801 Christine Kimble 13870 Briand Ave Orlando, FL 32827 200 S Orange Ave, Suite 2300 Orlando, FL 32801 Gregory Lee 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 Jim (Qualified) Gray 2021D1001 09 509 7 09 Jacob Stuart, Jr. Individual Attorney Check $500.0022 Individual R/E Broker Check $250.0023 Individual Public Safety Check $50.0024 Individual R/E Broker Check $100.0025 Individual Attorney InKind Reception $500.0026 Individual Attorney InKind Reception $200.0027 Individual Attorney InKind Reception $250.0028 01 21 30 21 29 21 09 29 21 09 29 21 09 24 21 09 30 21 09 30 21 09 30 21 8655 Randal Park Blvd Orlando, FL 32832 Jason Palinkas 9479 Becker Ct Orlando, FL 32827 Walter Lewis 7411 Chelsea Harbour Dr Orlando, FL 32829 Yog Melwani PO Box 394 Windermere, FL 34786 Mike Ryan 215 N Eola Dr Orlando, FL 32801 Greg McNeil 215 N Eola Dr Orlando, FL 32801 2006 Ivanhoe Rd Orlandop, FL 32806 Jonathan Huels 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 Jim (Qualified) Gray 2021D1001 09 609 7 09 William Dymond Individual Attorney InKind Reception $200.0029 Individual Attorney InKind Reception $851.6330 01 21 30 21 30 21 09 30 21 2080 W Fawsett Rd Winter Park, FL 32809 Rebecca Wilson 647 Bourne Place Orlando, FL 32801 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) Jim (Qualified) Gray 2021D1001 09 01 21 09 30 21 7 7 09 22 21 Consensus Media, LLC Electioneerin gCommunica tion $1,775.00 1 201 S Orange Ave, SUite 950 Orlando, FL 32801 Anedot, Inc 09 30 21 Monetary $38.30 7 1340 Poydras St, #1770 New Orleans, LA 70112 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