HomeMy WebLinkAboutTR ReportCAMPAIG/Nf TREASURER'S REPORT SUMMARY
OFFICE USE ONLY
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City, State,Zip C 13
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
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 Fl
Cover Period: From 3 tJ To _Z;�_ / 03 Report Type:
Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Cash &Checks —
Monetary r /
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 pate
$ -3 o0
(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 rep rt and it is true, correct, and complete:
II
(Type name) :f �)Q.{/�!)�/I�j[� (Type name)�I A4q 9,
(only for IE ❑ Treasurer ❑ Deputy Treasurer andidate ❑ Chairperson (only for PC and PTY)
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Signature Signature
DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS
(3) Cover Period _ / 0 / _ -,L through
I.D. Number
/* l (4) Page _L of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address 8
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
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(3) Cover Period /0 /_jQ / I S� through /Y\ (4) Page_of�_
(5)
Date
(T)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(
Purpose
(add office sought if
contribution to a
candidate)
(9)
Expenditure
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
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DS -DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES