HomeMy WebLinkAboutM7 Report 1)
(2)
(4)
CAMPAIGN TREASURER'S REPORT SUMMARY
7ArPV�.
Name _
Address (number and street)
City, State, Zip Code
❑ Check here if address has changed
Check appropriate box(es):
OFFICE USE ONLY
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(3) ID Number:
(Candidate Office Sought: ( /h/
Atlas
CC Of Sea 0
2�
" C'ffice
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or EGO 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 / j / To Report Type:
Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ • eq Expenditures $ .
Loans $
Total Monetary $ 1 ,
In -Kind $ 9 . L
(9) TOTAL Monetary Contributions To Date
$ V97 -
Transfers to
Office Account $
Total Monetary $ ,
(8) Other Distributions
(10) TOTAL Monetary Expenditures To Date
$ .4)
(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);
❑ Individual (only for IE reasurer ❑ Deputy Treasurer
or electioneering comm.)
X
Signature
DS-DE 12 (Rev. 11/13)
(Type name).f. ;), 11
E rbandidate ❑ Chairperson (only for PC and PTY)
Signature
SEE REVERSE FOR INSTRUCTIONS
AMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
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(1) Name��ill�dc, (2) I.D. Number !Q�
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(3) Cover Period / J / through / �L /} (4) Page of ice
(5) (7) ------ (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & C intributor Contribution In -kind
Number City, State Zip Code Tvoe Occupation Tvoe Description Amendment Amount
l l3� l 5;,- 0 e4l�l
z�
�j 3 3 �l !✓i� n�
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES
c`rce
(1) Name
_ (2) I.D. Number
(3) Cover Period
//_ through
_/_/ (4) Page of
(5)
(7)
(8) (9) (10)
(11)
Date
I
Full Name
Purpose
(Last, Suffix, First, Middle)
(add office sought If
Expenditure
Sequence I
Street Address &
City, State, Zip Code
contribution to a
candidate) Type Amendment
Amount
Number
DS•DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES