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Home My WebLink AboutM4 ReportCAMPAIGN TREASURER'S REPORT SUMMARY (1) Sebastian Citizens Speak Out OFFICE USE ONLY Name 973 Avenue RECEIVED (2) Oswego Address (number and street) MAY , 9 2�I6 Sebastian, Florida 32958 City of Seb City, State, Zip Code Ci astian ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): ❑ Candidate Office Sought: 0 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 04 / 01 / To 04 / 30 / 16 Report Type: M4 Original ❑ Amendment � ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , 200 .00 Expenditures $ 155. 00 Loans $_ - Transfers to _ Office Account $ Total Monetary $_ . 200 .06 Total Monetary $ 155. 00 In -Kind $ (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 5 1 781 25 $ 5 342 99 (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) Michael A. Goodfellow (Type name) Louise Kautenberg ❑ Individual (only for IE 0 Treasurer ❑ Deputy Treasurer ❑ Candidate EI Chairperson (only for PC and PTY) or electioneering comm.) X i( Alii 'O t! l Signature Signature DS -DE 12 (Rev. 11/13) 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. 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 filing officer. Report Type: refer to the filing officers 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: Original: first report filed for this reporting period. 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. 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 SEBASTIAN CITIZENS SPEAK OUT (2) I.D. Number (3) Cover Period 4 / 1 / 2015 through 4 / 30 / 2016 (4) Paae 1 of 1 (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 04! p4 !2016 GOODFELLOW, MICHAEL 1061 W. LAKEVIEW SEBASTIAN, FLORIDA 32958 I PRIVATE INVESTIG ATOR CBE --- --- 100.00 1 04 / 15 ?016 LOUISE KAUTENBERG 973 OSWEGO AVENUE SEBASTIAN, FLORIDA 32958 I REALTOR CHE -- -- 100.00 2 City Czar ylf e kSbo i0:: Q / t DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Type candidate's full name or name of the political committee (PC), committee of continuous existence (CCE) or party executive committee (PTY). (2) Type the identification number assigned by the Division of Elections. (3) Type cover period dates (e.g., 7/1/03 through 9/30/03 ). (See Calendar and Election Dates for appropriate year and cover periods.) (4) Type page numbers (e.g., 1 of 3). (5) Type 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 Division and for reporting amendments. For example, a Q1 report having 75 contributions would use sequence numbers 1 through 75. The next report (Q2), comprised of 40 contributions would use sequence numbers 1 through 40. Contributions on amended Q1 reports would begin with sequence number 76 and on amended Q2 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: Individual = I Business = B (also includes corporations, organizations, groups, etc.) Committees = C (includes PC's, CCE's and federal committees) Political Parties = P (includes federal, state ad county executive committees) Other = O (e.g., candidate surplus funds to party, etc.) Type occupation of contributor for contributions over $100 only. (If a business, please indicate nature of business.) (9) Enter Contribution Type using one of the following codes: NOTE: Cash includes cash and cashier's checks. DESCRIPITION CODE Cash CAS Check CHE In-kind INK Interest INT Loan LOA Membership dues DUE Refund REF (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 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 Q1 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 Q2 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 aline 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. Committees of continuous existence ONLY: Any contribution which represents the payment of dues by a member in a fixed amount pursuant to the schedule on file with the Division of Elections need only list the aggregate amount of such contribution, together with the number of members paying such dues and the amount of membership dues. CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name SEBASTIAN CITIZENS SPEAK OUT (2) I.D. Number (3) Cover Period 4 / 1 / 201-5 through 4 / 30 / 2016 (4) Page 1 of (5) Date (7) Full Name (Last, Suffix, First Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (6) Sequence Number 4 4 16 SEACOAST NATIONAL BANK 1110 ROSELAND ROAD SEBASTIAN, FLORIDA 32958 BANK FEES MON $155.00 1 NONE FOLLOWS ----- ----- --- R ,9 DS -DE 14 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Type candidate's full name or name of the political committee (PC), committee of continuous existence (CCE) or party executive committee (PTY). (2) Type identification number assigned by the Division of Elections. (3) Type cover period dates07/( 01/03 through 09/30/03 . (See Calendar and Election Dates for appropriate cover periods.) (4) Type page numbers (e.g., 1 of 2). (5) Type 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 Division and for reporting requirements. For example, a Q1 report having 40 expenditures would use sequence numbers 1 through 40. The next report (Q2), comprised of 30 expenditures would use sequence numbers 1 through 30. Expenditures on amended Q1 reports would begin with sequence number 41 and on amended Q2 reports would begin with sequence number 31. See Amendment Type instructions below. (7) Type full name and address of entity receiving payment (including city, state and zip code). (8) Type 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), CCEs 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: DESCRIPTION CODE Disposition of Funds (Candidate) DIS Monetary MON Petty Cash Withdrawn PCW Petty Cash Spent PCS Transfer to Office Account i ! TOA Refund REF (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 Cl 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) Type amount of expenditure.