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HomeMy WebLinkAboutTR ReportCAMPAIGN TREASURER'S REPORT SUMMARY OFFICE USE ONLY (Z) RF�Fit,F� �9z �L°D9i7iah �L �ft Oij City, State, Zip Code �9 C/ryC/eSebasOfj� ❑ Check here if address has changed (3) ID Number: ice (4) Check appropriate box(es): / Ercandidate Office Sought: 60:5 -1i �oU l .5� 4 n 4 7L y rl c ❑ 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 / 5 / Report Type: E�15riginal ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Cash & Checks $_ , _ , D . _ Monetary Expenditures $ , Loans $_ / Transfers to Office Account $ Total Monetary $ Total Monetary !�? In -Kind $_ (8) Other Distributions $ 0.— (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date 304 Z (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 rr,�)port and it is true, correct, and complete: //j �dI�Z (Type name) laf' /,, (TYPE name) /✓OJ ❑ Individual (only for IE �ireasurer ❑ Deputy Treasurer �andidate ❑ Chairperson (only for PC and PTY) or electioneeringcc000mmm.).,).,//n 7�J// X V U / r' �c !/ �(J W/! Signature Signature u5•ut U (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name � / 4 /q h (2) I.D. Number (3) Cover Period )0/ 2D/ 1.5 through // / S / _Lf (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 / 4b c; o CZ Of 9 S6 ?OJS 1 1 DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES AMPAIGJV�EASURER'S REPORT— ITEMIZED EXPENDITURES (1) Name CL J )c+ L (3) Cover Period /0 / 30 / / � through (2) I.D. Number (4) Page of (5) Date (T) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (6) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (6) Sequence Number ar m� a 1_ r 01�f n�� �7�, Fo. ,2 ' c�e� Q6aS CJS !i O cc, DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES