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CAMPAIGN TREASURER'S REPORT SUMMARY
OFFICE USE ONLY
Name �FCE/t FD
Address ,(number
h,n s� et) // 3� Ct?yCof�oba?PZO
Cit�\y, State, Zip Code L `O;Of
❑ Check here if address has changed (3) ID Number.
(4) Check appropriate box(es):
L7uandldate Office Sought
❑ Political Committee (PC)
❑ Electioneering Communications Ong. (ECO)
❑ Party Executive Committee (PTY)
❑ Independent Expenditure (IE) (also covers an
individual making electioneering communications)
❑ Check here If PC or ECO has disbanded
❑ Check here If PTY has disbanded
❑ Check here if no other HE or EC reports will be filed
(5) Report Identifiers
Cover Period:
From I,
To /Y I
ReportType:
61
❑ Original
❑ Amendment
❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Cash & Checks
$
Monetary
Expenditures
$ _ , G
Loans
$_J�. 00 Transfers to
Office Account
$
Total Monetary
$_
_
Total Monetary
$ �p (.
QD
In -Kind $
(9) TOTAL Monetary Contributions To Date
$ — , 100.
(8) Other Distributions
(10) TOTAL Monetary Expenditures To Date
$ _ — --)o
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (as. 839A3, F.S.)
I certify that I have ex/amin�eddtthis rrr on and it is We, correct, and complete:
(Type name) / O !'/ / a.i4 for (Type name) //)"� q/�`P—
❑ Indlyidual(only for lE Grtreasurer ❑ Deputy Treasurer M'EaMidele ❑ CM1e1rperson(only For PC eib PTY)
elecion
X7/7 X /;� w //A'
Signature Signature
DS-DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
AFC
I.D. Number
(1) Name
(2)
Cover Period �l f through / L7 / (4) Page
of ' Sw�
(3)
I
i
n
(5)
I
(T)
(a) (9) (10) (11)
(12)
Dale
Full Name
(6)
(Lent, Suffm Find. Middle)
Sequence
StmetAddms S
C ,ntributor Conftution in -kind
Number
CIStatell. ZJD Coddloe e TvOccupation Tvee Deeedotlon
a Amaunl
of �3f
rZkf'i
on,&L
Vrr
S ��dl�:n �rf4
atXJ.o
III
s"., I#& 4"W
f f
f /
DS-DE 13 (Rev. 11M3)
_EE REVERSE FOR NSTRUCTIONS AND CODE VALUES
R
�!i.. lIZ-)c`c�LFO
CAMPAIG TREAr,URER'S REPORT -ITEMIZED EXPENDITURES
(I)Name ��� !%•_�o r f Le. n (2) I.D. Number�� asla
n�
(3) Cover Period /through —f—/LIL/L2 (4) Page of
(5) nl (al m (10) 111)
Date Full Name Purpose
(S) (Last Suffix, First Middle) (add ofllea sought It FspenAWn
Sequence Street Address & contribution to e
Number City, State, Zip Code candidate) Type AmandmaM Amount
DS-DE 14 (Rev. 11113)
of Se-L*I Fi fih ( n (Ili
r Ge-
rfonl 6(•x
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES