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HomeMy WebLinkAboutG3 ReportCAMPAIGN TREASURER'S REPORT SUMMARY (1) A,4 1/�-v[ dk 1CGII (;j OFFICE USE ONLY Name (z) 17 4 iii ilge cl e Addre (nu bar and str ,S'eAitj19A 3 2-95 0CT 3ty 0 15 City, State, Zip Code C ofNaZO s ❑ Check here if address has changed (3) ID Number: ice (4) Check appropriate box(es): a / Xpandidate Office Sought: C I Ty C aJNG( 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 /o/ / /0/ Lf— To / 0 /29 / / Report Type: C ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report � Cash & Checks $_ , _ ,—p Monetary Expenditures Loans $_ _ , _ • _ Transfers to Office Account $ , Total Monetary $_ , _ , _ . Total Monetary $ q3721 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) i'\I cSi V4` � . Gc V/'Kn- (Type name) T I ChAd 4, t/ t Individual (only for IE ❑ Treasurer ❑ Deputy Treasurer Wandidate ❑ Chairperson (only for PC and PTY) or egn ectioneering comm.) X re Signature DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name <R(C�P41 �(��ot— �/ cy (2) I.D. Number (3) Cover Period 10 / *1 through ! v / F ( / � j� (4) Page 4 of (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 (11) Amendment (12) Amount (6) Sequence Number !o /Z2 /11' 1N y /iie� NQ-ryy �� K _Description ����h C -v R� I l c; C�t1 C+"ofSL e�kg las tiara roe I I DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN T E URER'S REPORT—ITEMIZED EXPENDITURES (1)Name eR ichAy-i /�,<//f12uY i (3) Cover Period �/—/W/ / 5 through /`� /7/ LI—N (2) I.D. Number (4)Page �of 1 (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (0) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (S) Sequence Number 119 tf ase ��°ti war AP Ali) tj /C'/j3/9-1 Posy off« L 9 a /ylA rN S+f � S s nl <„ �/% q F 2 -posTo� Z 90 tnRr�' S 2-0j SY Oct cCe cFfVF o DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES