HomeMy WebLinkAboutG3 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
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Name Fc�j�FO
Acct�ress (number and street) Cih
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City, State, Zip Code s Oda o
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
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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 / D l /'l l i To / 0 / 2- 9 / / r Report Type: C ' 3
RTIO_�(Iginal ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $ — —
Expenditures $ ,
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. 639.13, F.S.)
I certify that I haog examined this Zt a/ d it is true, correct, and complete:
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#4,!-i/l_C/r �y�'� ��
(Type name) Ow. .S (Type name) r(( Cut%
❑ Individual (only f easurer ❑ Deputy Treasurer 1316andidate Chairperson (only for PC and PTY)
or electioneering m.)
X X.'
Signature Signature
DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name )44141K� L'7//11fld4 ! (2) I.D. Number
(3) Cover Period /`9 / /% / /Jr through /-' / Lf / /7 (4) Page / 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
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
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DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1)
(3) Cover Period /D / /7 / /rthrough /o / Z
(2) I.D. Number
�i J (4) Page of
(5)
(T)
(8)
(g)
(10)
(11)
Date
Full Name
(Last, Suffix, First, Middle)
Purpose
(add office sought if
(8)
Sequence
Number
Street Address &
City, State, Zip Code
contribution to a
candidate)
Expenditure
Type
Amendment
Amount
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DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES