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HomeMy WebLinkAboutM3 Report DoellingCAMPAIGN TREASURER'S REPORT SUMMARY OFFICE USE ONLY 'Name `t` % S 1), A4 2-DJL�L RECE/VED (2) Address (number and str et) /;rk „ City, State, Zip Code Ciry Clesebasti an ❑ Check here if address has changed (3) ID Number: lice (4) Checkpropriate box(es): i /l /� andidate Office Sought:% / 79 ti ) A --,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 / / / G To 3 / 7:31 / Report Type: -ort ❑ Original ❑ Amendment ❑ Special Election Rep (6) Contributions This Report (7) Expenditures This Report Cash & Checks $_ , _ ,� OC-) Monetary Expenditures $i_7 — J Loans $_ , _ , _ . _ Transfers to Office Account $ Total Monetary $_ Total Monetary $ 3� In -Kind $ (8) Other Distributions (9) TOTAL Monetary Contributions To Date S 6 (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 f' (, �, �e9ELL. I N G (Type name) (,. )Cq G(.._1 Pic. 0 In 'gal (only for IE reasurer O Deputy Treasurer [T� Candidate 0 Chairperson (only for PC and PTY) or ,.ction ring V Signature ignature DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS Instructions for Campaign Treasurer's Report Summary (1) Name: full name of the candidate, political committee, party executive committee, electioneering communications organization, or Individual making an independent expenditure or electioneering communication. (2) Address: the full address or post office box, city, state, and zip code. 0 Check the box if the address has changed since the last report filed. (3) ID Number: identification number assigned by the filing officer. 4 Check the appropriate box(es). (5) Report Identifiers Cover Period: the dates this report covers (i.e.. From 1/1/15 To 1/31/55). Important: use the appropriate cover period dates as published by the riling officer. Report Type: refer to the filing officer's calendar of reporting dates for the correct codes to be used for each reporting period. If report is for a special election add "S" in front of the report code (i.e., SG3). Check one of the appropriate boxes: 0 Original: first report filed for this reporting period. 0 Amendment: must summarize only contributions/fund transfers and expenditures/distributions being reported as additions or deletions. Read instructions for sequence numbers and amendment types on the back of Forms DS-DE 13A and 14A. 0 Special Election Report: Important: once a special election report is filed, the entity is required to file all remaining reports due for the special election. (6) Contributions This Report: Cash and Checks: total amount for this reporting period. Loans: total amount for this reporting period. Total Monetary: sum of Cash and Checks and Loans. In-IMnd: the fair market value of the in-kind contribution at the time it is given for this reporting period. (7) Expenditures This Report: Monetary Expenditures: total amount of monetary expenditures for this reporting period. Transfers to Office Account: total amount transferred to an office account by elected candidates only. Total Monetary: sum of Monetary Expenditures and Transfers to Office Account. (8) Other Distributions: the total amount of goods and services contributed to a candidate or other committee by a PC, ECO, or PTY. (9) TOTAL Monetary Contributions To Date: the amount of total monetary contributions to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (19) TOTAL Monetary Expenditures To Date: the amount of total monetary expenditures to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (11) Type or print the required officer's name and have them sign the report: 0 Candidate report: treasurer and candidate must sign. 0 PC report treasurer and chairperson must sign. 0 PTY report: treasurer and chairperson must sign. 0 ECO report: organization's treasurer must sign. 0 IE or EC report individual must sign (this applies when an individual acts alone to make these expenditures) AMENDMENT REPORTS: An amendment report summary should summarize only & fund transfers being reported as additions or contributions, expenditures, distributions, deletions. Read the instructions for the sequence number & amendment type fields on the back of forms DS-DE 13, 14,14A and 94. F CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS c/ON/ S 6 j �Sb�s�i�l _ � (2) 1. D. Number (1) Nameoe (3) Cover Period / / 16 through 3 / -3r / (q) Page of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address& City. Slate, Zip Code (6) Contributor T e Occu ation (9) Contribution Type (10) In-kind Descri lion (11) Amendment (12) Amount (6) Sequence Number 3 , 3 , /6 F Gzbc s Po_` cz� 7S (eU0A) 2� O� 5 Z� • OCA 13/ ll�y t SCJ O' LA k� Fl_ ZD a / I t .= . j 1,moi Ott KtvtKst t -UK IMSTRUCTIONS AND CODE VALUES INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Candidate's full name or name of the political committee (PC), electioneering communications organizations (ECO) or party executive committee (PTY). (2) The identification number assigned by the filing officer. (3) Cover period dates (e.g., 1/1/15 through 1/31/15). (See filing officers reporting dates calendar for appropriate year and cover periods.) (4) Page numbers (e.g., 1 of 3 ). (5) Date contribution was RECEIVED (Month/Day/Year). (6) Sequence Number— Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and sequence number will combine to uniquely Identify a specific contribution, expenditure, distribution or fund transfer. This method of unique identification Is required for responding to requests from the riling officer and for reporting amendments. For example, a M1 report having 75 contributions would use sequence numbers 1 through 75. The next report (M2), comprised of 40 contributions would use sequence numbers 1 through 40. Contributions on amended M1 reports would begin with sequence number 76 and on amended M2 reports would begin with sequence number 41. See the Amendment Type instructions below. (7) Type full name and address of contributor (including city, state and zip code). (8) Enter the type of contributor using one of the following codes: Occupation of contributor for contributions over $100 only. (if a business, please indicate nature of business.) I Individual CAS B Business also includes corporations. organizations, groups, etc. E ElectioneeringCommunications Organizations INK F Political Committee federal or state LOA Loan (includes federal, state and county executive P Political Parties committees 01 Other e.., candidate su lus funds to party, etc. S Candidate to Self (9) Enter Contribution Type using one of the following codes: NOTE: Cash Includes cash and cashier's checks. Code Descri tion CAS Cash or Cashier's Check CHE Check COF Car over Funds from Previous Cam ai n INK In -Kind INT Interest LOA Loan MO Mone Order MUC I Multi le Uniform Contributions RCT I Other Receipts REF I Refund Ne auwAmountOnl %c /t/ APR , �' 5141 C;e��sbasfra (10) Type the description of any in-kind contribution received, 06 ca Candidate's Only— If in-kind contribution is from a party executive committee and is allocable toward the contribution limits, type an "A" in this box. If contribution is not allocable, type an "N". (11) Amendment Type (required on amended reports) — To add a new (previously unreported) contribution for the reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data. The sequence number for contributions with amendment type "ADD" will start at one plus the number of contributions in the original report. For example, amending an original bIl report that had 75 contributions means the sequence number of the first contribution having amendment type "ADD" will be 76; the second "ADD" contribution would be 77, etc. When amending an original b12 report that had 40 contributions, the sixth "ADD" contribution would have sequence number 46. To correct a previously submitted contribution use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the contribution to be corrected. In combination with the report number being amended, this sequence number will identify the contribution to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (12) Type amount of contribution received. Political Committees ONLY: Multiple uniform contributions from the same person, aggregating NMT $250 per calendar year, collected by an organization that is the affiliated sponsor of a PC, may be reported by the PC in an aggregate amount listing the number of contributors together with the amount contributed by each and the total amount contributed during the reporting period. The Identity of each person making such uniform contribution must be reported to the filing officer by July 1 of each calendar year, or, in a general election year, NLT the 60th day immediately preceding the primary election. r' qPR 4�cFi�Fo C yC/ �� O ?Q� ' N-rALPA�RE?S�1RER'SREeORT-ITEMIZEDEXPENDITURES �Oe ( ) ame L CSL ! / (2) 1.6. dumber (3) Cover Period / % / /(0 through /31 / / p (4) Page Ifo —I (5) (7) Date Full Name Purpose (6) (Last, Suffix, First, Middle) (add office sought it Sequence Street Address 8 contribution to a Expenditure Number City, State, Zip Code candidate Type Amendment Amount 3 0 -�i4r✓ 44 �(6 WrP�4e.,1 f�til��2S`G� 31 10A -�l C A Vl r4 4)E760128 a �D / 3� ' DS -DE iw tRev. -I IM3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 4 R L OC' �. c"ONI, s C/C." s osl,4/S INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Candidate's full name or name of the political committee (PC), electioneering communications organization (ECO), or party executive committee (PTY). (2) Identification number assigned by the filing officer. (3) Cover period dates (01/01/15 through 01/31/15). (See filing officer's reporting dates calendar for appropriate cover periods.) (4) Page numbers (e.g., 1 of 3). (5) Date of expenditure (klonth/DayNear). (6) Sequence Number - Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer. This method of unique identification is required for responding to requests from the filing officer and for reporting requirements. For example, a Mt report having 40 expenditures would use sequence numbers 1 through 40. The next report (N12), comprised of 30 expenditures would use sequence numbers 1 through 30. Expenditures on amended Mt reports would begin with sequence number 41 and on amended M2 reports would begin with sequence number 31. See Amendment Type instructions below. (7) Full name and address of entity receiving payment (including city, state and zip code). (8) Purpose of expenditure (if expenditure is a contribution to a candidate, also type the office sought by the candidate). PLEASE NOTE: This column does not apply to candidate expenditures, as candidates cannot contribute to other candidates from campaign funds. However. PCs (supporting candidates) and party executive committees contributing to candidates must reoort office sought (Section 106.07, F.S.). (9) Enter Expenditure Type using one of the following codes: Code Description CAN Candidate Expense DIS Disposition of Funds DFC Disposition of Funds to Future Campaign (effective 11/1/13 DPP Disposition of Funds to Political Part effective 11/1/13 DPV Disposition of Funds to Petition Verification effective 1111/13) ECC Electioneering Communication IEC Independent Expenditure Regarding a Candidate IEI Inde endent Expenditure Regarding an Issue MON Moneta (Not to a Candidata PCN/ Pett Cash Withdrawn PCS Pett Cash S pant PPD Pre- aid Distribution REF Refund Pla ativeAmountOnl RMB Reimbursements TOA Transfer to Office Account (Disposition of Funds (10) Amendment Type (required on amended reports) - To add a new (previously unreported) expenditure for the reporting period being amended, enter "ADD" in amendment type on a tine with ALL of the required data. The sequence number for expenditures with amendment type "ADD" will start a: one plus the number of expenditures in the original report. For example, amending an original M7 reports that had 75 expenditures, means the sequence number of the first expenditure having amendment type "ADD" will be 76; the second "ADD" expenditure would have sequence number 39. V To correct a previously submitted expenditure use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the expenditure to be corrected. In combination with the report number being amended, this sequence number will identify the expenditure to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (11) Amount of expenditure.