HomeMy WebLinkAboutG1 ReportCAPAiGN TREASURER'S REPORT 91ARA1fY
(1) 1/1 e ^ /t/N 6L 122 z 1, f J OFFICE USE ON4Y
Name
Adyiress (nuMber ar stre/etl
o.. u.5 J e2 r—,..
City, State, Zip Code _ _ _ . _ _ A
❑ Check here If address has changed (3) ID Number:
(4) Check appropriate box(es): 7
Lt Candidate Office Sought: C,'' i y U/✓ r_ %
Ej Political Committee (PC)
❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded
[j 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 Identifiis
Cover Period: From /o / 140 To Report Type:
LJN Orighal ❑ Amendment ❑ Special Election Report
(6) C-,Intributions This Report (7) Expenditures This Report
Monetary
Cash 8: Checks $ • — Expenditures $
Loans $ _
Total Monetary $ —
In -Kind $
Transfers to
Office Account $
Total Monetary $
(8)
(9) TOTAL Monetary Contributions To Date (10)
f �—
Other Distributions
$ _A?L _
TOTAL Monetary Fxpen Itures To Date
61) Certification
It is a first degree misdemeanor for any person to falsify a public record (as, 839.13, F.S.)
I c y that I have amined this report and It is true correct, and complete:
( O / S (iiv (Type name) L -E C ti_
❑ indhndual (only for IE PTreasurer Deputy Treasurer ❑ Candidate 0 Chalrpenmr, (only for PC and PTY)
or electioneering
M
X��_
Signature
DS-DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
R�C,cjl
CAMPAIGN TREASURER'S
REPORT - ITEMIZED CONTRIBUTIONS
(1) Nairne
v .v a, ��
/ jmnJ
(2) I.D. Number
(3) Coos Period/ I / / � through G� l
P 1 (4) Page
of
(5)
(7)
(S)
(9) (10) It 1)
(12) -
Date
Full Name
(6)
(Last Suffix, First, Middle)
Sequence
Street Address &
I
Contributor
Contribution In -kind
Number
City, State, Zi CQde
Type Occupation
- Typal Descri on Am em
Amount
1 !
/
DS-DE 13 (Rev, 11113) 1 SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
f2 CAMPAIGN TREAS�t1 ER'��EPORT— ITEMIZED EXPENDITURES
(t) Name f Z n_ A,, Al CC, r9 / / (2) I.D. Number_
(3) Cover Period through �� I_�l (4) Page
of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address d
City, State, 21p Code
(8)
Purpose
(add office sought It
contribution to a
candidate)
(9)
Expenditure
Type
(10)
Amendment
(11)
Amourt
(s)
Sacuence
Number
f
I
�r
OS -DE 4 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES