HomeMy WebLinkAboutM4 ReportCAMPA TREASURER'S REPORT SUMMARY
(1) _� OFFICE USE ONLY
Name
(2)
Address (number and street)�i FO
JAZ
City, State, Zip Code
❑ Check here if address has changed (3) ID Number: a O'
(4) Check appropriate box(es):
'Candidate 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)
Report Identifiers �
Cover Period: From / />; To /< Report Type:
❑ Original ❑ Amendment ❑ Special fElection Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ Expenditures $ oa
Loans $_ Transfers to
Office Account $
Total Monetary
Total Monetary $
In -Kind $ • _
(8) Other Distributions
$
(9) TOTAL Monetary Con i ions To Date (10) TOTAL Monetary Expenditur 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 In examined this report and it is true, correct, and complete: /
(Type name) <i?l
/ etc ttt(---,,Tfffype name) � ea
❑ Individual{only Treasurer ❑Deputy Treasurer yrs Candidate ❑ C on (only for PC and PTY)
or ele oneering com
X
Signature Signatu e
DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS li�'�.��
(1) Name (2) I.D. Number
/Pfd %
(3) Cover Period 4 / ( / 050 through jZ / _,60/ ae> (4) Page of
x.
(6) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address& Contributor
Number City, State, Zip Code Type Occupation
Contribution In-kind
Type Description Amendment Amount
Loo ? -0, XY0
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
R
�cF�L
C,yC�d�seba `G`�
CAMPAIGN A RF ,. REPORT — ITEMIZED EXPENDITURES ks(2) I.D.Number ��r
(1) Name _ i
f1
(3) Cover Period �f / / o>� through z / / r (4) Page of
(5) (7) (8) (g) (10) (11)
Date Full Name Purpose
(6) (Last, Suffix, First, Middle) (add office sought if
Sequence Street Address & contribution to a Expenditure
Number City, State, Zip Code candidate) Type Amendment Amount
- 14
0,9
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES