HomeMy WebLinkAboutM9 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
(1) �.'Jlfb NNQ�AJs,J OFFICE USE ONLi-(;;�/VE.7
!dame �—
r ,
(2) I; i ti Jr. fir,^ l
d ress�nu nber anti street) L'ty ,I g u' '
n. rJ�-S yaw c �=itj� C1e,7 c a 1ia,
City, State, Zip Code
❑ Check here If address has changed
(4) Check appropriate box(es):
,f9 Candidate Office Sought: C','Ttil
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO)
Party Executive Committee (PTY)
❑ Independent Expenditure (IE) (also covers an
individual making electioneering communications)
(3) ID Number: �4/,j ,
co f
❑ Check here if PC or ECO has disbanded
❑ Check here if PTY has disbanded
❑ Check here If no other IE or EC reports will be filed
(5) Report Identifiers
Cover Period: From __9� 1 _L / >a_ To 0? / 3Q / o Report Type:
J�Qriginai El Amendment ❑ Special Election Report
ll (6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ _ . _ Expenditures $ /
Loans $ Transfers to
Office Account $
Total Monetary$ � _
Total Monetary $ L C�
In -Kind $�
(8) Other Distributions
(9) TOTAL -Monetary -Contributions To Date (10) TOfAL Monetary,Expen itures To Date
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (as. 839.13, F.S.)
I cec, I at I have exam' d this report and It is true, coned and complete:
(TY n 4 (Type narri U t_:
0 ndividual (on[ r easurer Deputy Treasurer ❑ Candidate t] Chairperson (only for PC and PTY)
or elacuonsed M.)
Si ature Signature
DS-DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name a A✓ a,
/ I d�it% (2)
I.D. Number
(3) Cover Period / !,2�a
through I �o l gO
(4) Page
of
(51
(7)
(8) (9)
(10)
01) (12)
Date
Full Name
(6)
(Lest, Suffix, First Middle)
Sequence
Street Addres &
C intributor Contribution
In -kind
Number
City, State, Zi Cafe
Type Occupation Type
Description
Ame err Amount
Or
DS-DE 13 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREA ER' SPORT— ITEMIZED EXPENDITURES
C r;
"tee
(1) N--ale /1 J/ ir_ /h/ J✓ G. /l ep / 0 Aj (2) I.D. Number
(3) Cover Period / / / through �! / (4) Page of
(S) (7) IB) (9) (10) (11)
Date Full Name Purpose
(6) (Lest, Suffix, first, Middle) (add office sought If
Sequence Street Apdress d contribution to a Expenditure
Number City, Sta1 , Zip Code candidate) Type Amendment Amount
66, s ten; ai O o
OS-DF. ".A (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES