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HomeMy WebLinkAboutG3 ReportCAMPAIGN TREASURER'S REPORT SUMMARY OFFICE USE ONLY r RFCFitr�o (2) _ ress number and stree 91ps z5P City, State, Zip Code Sty �C/er �basr ❑ Check here if address has changed (3) ID Number: c (4) Check appropriate box(es): % C Candidate Office Sought: Se {ioc A Q � C � I/ ot( nC, I ❑ 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 /L9 / / To �� / / Report Type: G 3 t�uriginal ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $_ _ , �C �. Expenditures $ Loans $_ , _ • Transfers to Office Account $ , Total Monetary $_ _ , lvE>� d Ci Total Monetary $ 3 15• DO In -Kind $_ _ , o�� . �Q (8) Other Distributions $ (9) TOTAL Monetary ontributions To Date (10) TOTAL Monetary Expenditures To Date $ 1, 3 $ f?3a. ? (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 halvee(Jgxammed thisre ort and it is true, correct, and complete: Pr (Type name) /�J O`J /q y) (Type name) �Q 1 yl ❑ Individual (only for IE ©"Treasurer ❑ Deputy Treasurer Candidate ❑ Chairperson (only for PC and PTY) or electioneering comm.) Signature Signature DS -DIE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name /Jt t / y" (2) I.D. Number (3) Cover Period / ® / % ? / / j through /o / a ? / /S (4) Page of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address& City, State, Zip Code1 (8) Contributor Type Occupation (9) Contribution Type (10) In-kind Description (11) Amendment (12) Amount (6) Sequence Number �u l l P � % K�/7co/1 Efsautl/k". 1190. )60k L569 &e a4eX I h 3J?Zl 5m.00 =E on a�a F, sf IDD.(� ©,�a / l s �����.7q J2��el %or�wIAssn �(77 & ('V'Ra r L�nl�� 44 e xl or S 0 I l ClyyOfS C/e�k ?�1S astig Oboe DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES AMPAIGN�EASURER'S REPORT- ITEMIZED EXPENDITURES (1) Name 6 EyA L/A'C��F (3) Cover Period / 0 / 17 //,� through (2) I.D. Number (4) Page of (5) Date (T) 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) Amendment (11) Amount (8) Sequence Number DSPs ✓ago ///�q,n //� 7 SC�gS'ii4n YL 3a95� v .�S �G S 175',DO . /?�7DrgA,96 3MO 60 /O 315 LlsPS,// l 7600 RFcF�� Orr d c; ?O1 46 %rksasr'an Oboe DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES