HomeMy WebLinkAboutM9 Report KinchenCAMPAIGN TREASURER'S REPORT SUMMARY
(1) - Q Y) &a klnc heti
Name
(Z) I qh he'� rnrtif .
Address1 ^(nu_mbe{ and street)
F -L -2
City, State, Zip Code '
❑ Check here if address has changed
(4) Check appropriate box(es):
,Candidate Office Sought:
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO)
❑ Party Executive Committee (PTY)
❑ Independent Expenditure (IE) (also covers an
individual making electioneering communications)
OFFICE USE ONLY
Oct 1 FI�Fo
Cllyof?016
01� Ole k,s C'Inan
(3) ID Number:
❑ Check here if PC or ECO has disbanded
❑ Check he?e if PTY has disbanded
❑ Check here if no other IE or EC reports will be filed
(5) Report Identifiers
Cover Period: From 9 / ( / To / 30 / b Report Type: � Cj
2`66ginal ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks S
Loans
Total Monetary $ I I ,
In -Kind $1 1 .
(9) TOTAL Monetary Contributions To Date
(7) Expenditures This Report
Monetary
Expenditures $ ► OG
Transfers to
Office Account $
Total Monetary $ _ (0(, 00
(8) Other Distributions
$ ,
(10) TOTAL Monetary Expenditures To Date
S , $53. i43.
(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 truc, correct, end complete:
(Type name) Waa V
❑ Individual (only (orlm— Treasurer ❑ Deputy Treasurer
or electioneering comm.)
X A-ncu Vs_�_Cd- _
Signature
DS -DE 12 (Rev. 111131
(Type name) %. / /U1i f} 4'1 IV C� eA)
Candidat=_ ❑ Chairper_on (only r„ rPC end PTY)
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occ rcv crest rUK 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 111/15 To 1/31/55). Important: use the appropriate
cover period dates as published by the filing officer.
of reporting dates For the correct codes to be used for
Report Type: refer to the filing officer's calendar
each reporting period. If report Is fora special election add "S" in front of the report code (i.e., 503).
Check one of the appropriate boxes:
0 Original: first report filed for this reporting period.
transfers and expenditures/distributions being
0 Amendment: must summarize only contributions/fund
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 -Kind: the fair market value of the in-kind contribution at the time it is given for this reporting period.
(7)
Expenditures This Report:
expenditures for this reporting period.
Monetary Expenditures: total amount of monetary
TransFers to Office Account: total amount transferred to an office account by elected candidates only.
Total Monetary: sum of Monatary Expenditures and Transfer to Office Account.
(6)
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.
time the campaign depository Is opened through the
Candidates keep cumulative totals from 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.
D PC report: treasurer and chairperson must sign.
�7 PTY report: treasurer and chairperson must sign.
,DECO 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, 14Aand 94.
2
CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIOt ,�ofsl6p
C/e�'�sbasr. %6
(1) Name U n&cA_ Vl (hP F'1 (2) I.D. Number dos
(3) Cover Period 9 / I / ((O through __�N/ 30/ lito (4) Page _L of _L
(5) (7)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address &
Plumber Cit , Stale, Zio Code
/ 1
(6) (`�)
Contributor Contribution
T� a Occu anon T e
(I6)
In-kind
D=_scri lion
(11)
Amendment
(12)
Amount
I f /
.._�
......----
--._ ....
n;_n:� ie ram„ ilh,I
-�- IalMUUlluiib ANU GORE 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., 1IU15 through 1131115). (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 (Mlonth/DaylYear).
(o") Sequence Number— Each detail fine 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 PAI 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 MI2 reports would begin with
sequence number 41. See the Amendment Type Instructions below.
(7) Type full name and address of contributor (including city, slate 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
B
Business
also includes corporations, or anizations, groups. etc.
E
Electionearin Communications Or anizations
F
Political Committea
federal or stats
Recei is
(includes federal, state and county executive
P
Political Parties
committees)
------------------
e.., candidate sur lus funds to party, etc.
0
Other
S
Candidate to Self
(9) Enter Contribution Type using one of the folloviing codes:
NOTE: Cash includes cash and cashier's checks.
Description
ash or Cashier's CheckCheckFunds
WuashorCashbar's
from Previous Cam ai nIn-KindInterestLoanMlonei
Orderi
le Uniform Contribu?ions,Other
Recei is
REF
I P.efund Ne_gatfve 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 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 al 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
cing the dropped data. Assign the sequence number as described
with the necessary corrections thus repla
above.
(12) Type amount of contribution received, Political Committees ONLY: Multiple uniform contributions from the
same_ person, aggregating NiNIT $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.
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CAI`APAIGN TREASURER'S REPORT— ITEMIZED EXPENDITURES 'y'ce
N
1 I_ [� h
O ame 1Y \h Pit
(2) I.D. Number
(3) Cover Period 9 / / 1 (0 through I / 30/ t (0 (q) Page_ of
Date(11)
Full Name Purpose
(Last, Suffix, First, Middle) (add office sought if
Street Address & contribution to a Expenditure
City, State, Zip Code candidate) Type
(10)
Amendment
Amount
(g)
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 (01101115 through 01131/15). (See filing officer's reporting dates calendar for appropriate cover
periods.)
(4) Page numbers (e.g., 1 of 3).
(5) Date of expenditure (MonthlDayNear).
(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 reoort office sought (Section 106.07, F.S.).
(9)
Enter Expenditure Type using one of the following codes:
(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.
e number for expenditures with amendment type "ADD ;+iil staiL at ale pbls the number of
The sequence
expenditures the original report. For example, amending an original Nil reports that had 75 expenditures, means
iture having amendment type "ADD" will b=_ 76: the second "ADD"
the sequence number of the first expend
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.