HomeMy WebLinkAboutG1 ReportCAMPAIGN T SURER'S REPORT SUMMARY
(1) P61il`TQ�a f 0 air ( ,S OFFICE USE ONLY
/� I L EC QED
(Z) Name „ / 6_f ra 1A ST . Or "
Address (n tuber and street) ^ q 9 J 201
01 4I " �o J l CC city of Seb /9
C,�erk- `van
City, State, Zip Code ' Mtn
❑ Check here if address has changed (3) ID Number:
(4) ,Ch,e�cck appropriate box(es):
Lytiandidate 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
nttifiers J
Cover Period: From I (� / / To I t' / `– Report Type:
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $_ , _ — • _ Expenditures $
Loans $_ , _ , 0 Transfers to
Office Account $
Total Monetary $ _ ,
Total Monetary $ ,
In -Kind $ • _
(8) Other Distributions
$ 1
(9) TOTAL Monetary Contributiorys U ate (10) $ TAL Monetary Exp i res q Date
$ Iic�L�t�7�L� lV�_
(11) Certification
It is a first degree misdemeanor for any person to falsify a publi record (ss. 839.13, F.S.)
I certify that I ha examined this report a is true, correct, and complete: (�
(Type name) ha
�� (Type name) r__
El Individual (only for IE D—rreaasurer ❑ D puty Treasurer and/id/at/tee ❑ Ch�air�perr/soon (only for PC and PTY)
or electiont comm.,✓ 7/if/t�Tl�/Signature Signature
Signature
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
MPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
( Q n OC'j
c/ffCe&. ,-
1 Name
/(2)) I.D. Number
(3) Cover Period __L01/ J1 through 10/cif 1 J (4) Page of `e
(5) 1 (7) (S) (9) (10) (11) (12)
Date
Full Name
(6)
(Last, Suffix, First, Middle)
Sequence
Street Address &
Number
City, State, Zip Code
Contributor Contribution
Type Occupation Type
f -ea 1 41
W1
In-kind
Description Amendment Amount
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
11FCE/�,
�C �C
COIPA] fN TRrSU S REPQRT- ITEMIZED EXPENDITURES ryc tseb A'"
(1) Name IY/Pt�d�P II (J\ 0� (� > (2) I.D. Number
(3) Cover Period / 0/�/ through / / I / (4) Page I of
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
/G, i (Last. Suffix. First. Middle) (add office souaht if
9
DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Amount