HomeMy WebLinkAboutM4 Report DoellingCAMPAIGN TREASURER'S REPORT SUMMARY
�be e r `� �O OFFICEUSE ONLY
(1)
hh C�IVE1)
Name
c2) (-'J!{4.tga0
(-'J
-j
(number and str et) 2016
.Add�res�s
v of se ba
Cler stian
City, State, Zip Code 1 s Ofrce
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es): �r
B/6andidate OffceSought: T% %-
❑ 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)
(6) Report Identifiers
Cover Period: From 0 T / c/ / 20/e, To � T Report Type: my
Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Cash & Checks $j. OO
Monetary
Expenditures $
Loans $
Transfers to
Office Account $
Total Monetary $_00-00
Total Monetary $ . Co
In -Kind $ • _
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date
(10) TOTAL Monetary Expenditures To Date
$
$ Yo - 7.
(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) .L.Jr'� L-V-��O�E* I'`j b (Type name) t,�r U - y
❑ Individual (only for IE I5xreasurer ❑ Deputy Treasurer andidate ❑ Chairperson (only for PC and PTY)
orglecl' veering comm.)
nature ature
DS -DE 12 (Rev. 11113) SEE REVERSE FOrINSTRUCTIONS
'
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.
❑ Check the box � 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).
(6)
Report Identifiers
Cover Period: the dates this report covers (i.e., From 1/1/15 To 1/31/551. Important: use the appropriate
cover period dates as published by the filing 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., Ste.
Check one of the appropriate boxes:
❑ Original: first report filed for this reporting period.
D 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.
❑ 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 -Kind: 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.
(10)
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:
❑ Candidate report: treasurer and candidate must sign.
D PC report: treasurer and chairperson must sign.
❑ PTY report: treasurer and chairperson must sign.
❑ ECO report: organization's treasurer must sign.
❑ 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
contributions, expenditures, distributions, & fund transfers being reported as additions or
deletions. Read the instructions for the sequence number & amendment type fields on
the back of forms DS -DE 13, 14, 14A and 94.
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name�. b Lel A.) (2) I.D. Number
(3) Cover Period VC1 / Ol / ZO/C through O—C / W / 2,0j G (4) Page of
(5)
(7)
(8)
(9)
(10)
(11)
(12)
Date
Full Name
(Last, Suffix, First, Middle)
(6)
Sequence
Street Address&
Contributor
Contribution
In-kind
Number
City, State, Zip Code
Type Occupation
Type
Description
Amendment
Amount
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DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS 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 (PTI).
(2) The identification number assigned by the filing officer.
(3) Cover period dates (e.g., 1/1/15 through 1/31/15 . (See filing officer's reporting dates calendar for
appropriate year and cover periods.)
(4) Page numbers (e.g., 1 of 3).
(5) Date contribution was RECEIVED (Month/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 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
Electioneering Communications Organizations
INK
F
Political Committee
federal or state
P
Political Parties
(includes federal, state and county executive
committees
O`"
Other
e.., candidate surplus funds to party, etc.
S I
Candidate to Self
REF
(9) Enter Contribution Type using one of the following codes:
NOTE: Cash includes cash and cashier's checks.
Code
Description
CAS
Cash or Cashier's Check
CHE
Check
COF
Carryover Funds from Previous Campaign
INK
In -Kind
INT
Interest
LOA
Loan
MO
Money Order
MUC
Multi le Uniform Contributions
RCT
Other Recei is
REF
Refund (Negative Amount Only)
(10) Type the description of any in-kind contribution received.
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 anew (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 M1 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 M2 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.
CAMPAIGTR SURER'S REP RT — ITEMIZED EXPENDITURES
(1) Name �7Y L �e �� °t LL iT, (2) I.D. Number /
(3)Cover Period �/0 / /?.D/(,through&V /36 -0/( (4)Pageof /
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(e)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Expenditure
Type
(10)
Amendment
(71)
Amount
(6)
Sequence
Number
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DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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 �).
(5) Date of expenditure (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 filing officer and for reporting
requirements.
For example, a M1 report having 40 expenditures would use sequence numbers 1 through 40. The next report
(M2), comprised of 30 expenditures would use sequence numbers 1 through 30. Expenditures on amended M1
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 report 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 11/1/13
ECC
Electioneering Communication
IEC
Independent Expenditure Regarding
a Candidate
IEI
Independent Expenditure Regarding
an Issue
MON
Moneta Not to a Candidate
PCW
PettyCash Withdrawn
PCS
PettyCash Spent
PPD
Pre aid Distribution
REF
Refund (Negative Amount Only)
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 line with ALL of the required data.
The sequence number for expenditures with amendment type "ADD" will start at one plus the number of
expenditures in the original report. For example, amending an original M1 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.
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.