HomeMy WebLinkAboutM8 Report AmendmentCAMPAIGN TREASURER'S REPORT SUMMARY
//
OFFICE USE ONLY
Name
(2) 2 V -( K
Addres (numpper and street• 1 S �Q
c'lty of 15
CV
City, State, Zip Code C/e kepastian
❑ Check here if address has changed e
g (3) ID Number:
(4) Check appropriate box(es):
Candidate Office Sought: /UC( L
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 / l / / To (�- / 3 1 / /,_S' Report Type:
❑ Original Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
\
Cash &Checks $� , • J
C
Monetary
Expenditures $ _ , P3 ?�
Loans $ , _ • _
Transfers to
Office Account $
Total Monetary $� , � Z S
Total Monetary $ 3 , e�
In -Kind $_ , _ • _
(8) Other Distributions
$
(9) TOTAL Monetary Contributes To Date
$ / 0 �
(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:
_ 1' / /
(Type name) )� fU7 �l'�f � (j- [>llli'i�' (Type name)R,4 A V,4 4 , 6-1 l/ / / C',"
❑ Individual (only for IE ❑ Troasurer ❑ Deputy Treasurer ❑ Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X a
Signa ure Signature
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name �Vt `—} i C l/�� (2) I.D. Number
(3) Cover Period q / 0 l / / ]E through f / 2 I / l,� (4) Page A of °2-
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Contributor
Type Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
l l
7 2 1' /Aye 67 "ilk
-�j> bt25NAJ
9S5f
%U
C//y
cf
Fi�Fo
S
I 1
0/yr
astla
offloe
! I
DS -DE 13 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES