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Home My WebLink AboutG3 Amended ReportCAMPAIGN TREASURER'S REPORT SUMMARY Name (1) ck-CA-e'. P OFFICE USE ONLY RFCF�V (2) qU4 s. FI ow %'A c_ �1-• pC F,) Address (number and street) C %o 0 �Cl6ti i•i2. FL.'IRq SF C. Ili- «29 City, State, Zip Code po�h'sbnSGan ce ❑ Check here If address has changed (3) ID Number: C �3 153 C (4) Check appropriate box(es): 1 *0/1 L7 c:andidate Office Sought: ❑ Political Committee (PC) ❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded C/or�ebdsi�: ❑ Party Executive Committee (PTY) ❑ Check here if PTY has disbanded O'c� ❑ 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 10 / 1"? 1.2074 To t0 / 24 *ORO Report Type: 906riginal Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $_ !� . 0u Expenditures $ Loans $_ Transfers to Office Account $ Total Monetary $_ _ Total Monetary $ In -Kind $_ _ (8) Other Distributions $ 1 , (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date (11) Certification It is a first degree misdemeanor for any person to falsify a public record (as. 839.13, F.S.) I certify that I have'1 examined this report and it is true• correct, and complete: I (TYpename) �h'ln�v1 F�a+� (Type name) �h'er,.I1 L]e arf ❑IndMdoal(only for lE Measurer ❑Deputy Treasurer I9<a�idate ❑ Ch.i",son(only for PC aid PTY) or cleclloneenngg coomm X / -tce X Signature Signature OS -OE 12 (Rev. 11 F13) SEE REVERSE FOR INSTRUCTIONS Instructions for Campaign Treasurer's Report Summary (1) Name: full name of the candidate, political committee, party executive committee, electioneering communications organization, or Individual making an Independent expenditure or electioneering communication. (2) Address: the full address or post office box, city, state, and zip code. ❑ Check the box If the address has changed since the last report filed. (3) ID Number: Identification number assigned by the filing officer. (4) Check the appropriate box(es). (5) Report Identifiers Cover Period: the dates this report covers (i.e., From IJILL5 To 1131155). Important: use the appropriate cover period dates as published by the filing officer. Report Type: refer to the filing officers calendar of reporting dates for the correct codes to be used for each reporting period. If report is for a special election add'S" in front of the report code (i.e.. SG3). Check one of the appropriate boxes: E Original: first report filed for this reporting period. Amendment: must summarize only contributions/fund transfers and expenditures/distributions being reported as additions or deletions. Read instructions for sequence numbers and amendment types on the back of Forms DS-DE 13A and 14A, Special Election Report: Important: once a special election report is filed, the entity is required to file all remaining reports due for the special election. (6) Contributions This Report: Cash and Checks: total amount for this reporting period. Loans: total amount for this reporting period. Total Monetary: sum of Cash and Checks and Loans. In -Kind: the fair market value of the in -kind contribution at the time it is given for this reporting period. (7) Expenditures This Report: Monetary Expenditures: total amount of monetary expenditures for this reporting period. Transfers to Office Account: total amount transferred to an office account by elected candidates only. Total Monetary: sum of Monetary Expenditures and Transfers to Office Account. (6) Other Distributions: the total amount of goods and services contributed to a candidate or other committee by a PC, ECO, or PTY. (9) TOTAL Monetary Contributions To Date: the amount of total monetary contributions to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (10) TOTAL Monetary Expenditures To Date: the amount of total monetary expenditures to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (11) Type or print the required officer's name and have them sign the report: F Candidate report: treasurer and candidate must sign. o PC report: treasurer and chairperson must sign. ❑ PTY report: treasurer and chairperson must sign. ECO report: organization's treasurer must sign. IE or EC report: individual must sign (this applies when an individual acts alone to make these expenditures) AMENDMENT REPORTS: An amendment report summary should summarize only contributions, expenditures, distributions, & fund transfers being reported as additions or deletions. Read the instructions for the sequence number & amendment type fields on the back of forms DS-DE 13, 14, 14A and 94. R -0 C,. yo/ lG9n Sao. CAMPAIGN TREASURER'S REPORT— ITEMIZED EXPENDITURES (1) Name reokn i. n 1p —>a P (2) LD. Number r-3 (3) Cover Period (0through jd_/_9 I / .k& (4) Page ( of ) (5) (T) (a) (9) (10) (11) Date Full Name Purpose (S) (Lest, Suffix, First, Middle) (add office Bought If Expenditure Sequence Street Address & contribution toe pe e Number City, Slate, Zip Code candidate) YP Amendmerd Amount (U a-12d70 G.'2\ S1.r^\ lf1N l(Sz LtI 14�`f'1— 3 1' s.�be.i-tw F. sa4sr DS-DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT • ITEMIZED EXPENDITURES (1) Candidate's full name or name of the political committee (PC), electioneering communications organization (ECO), or party executive committee (PTY). (2) Identification number assigned by the filing officer. (3) Cover period dates 01 1115 through 01/31/15). (See filing officer's reporting dates calendar for appropriate cover periods.) (4) Page numbers (e.g.,1 of 3). (5) Date of expenditure (Month/DayNear). (6) Sequence Number - Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer. This method of unique identification is required for responding to requests from the filing officer and for reporting requirements. For example, a M1 report having 40 expenditures would use sequence numbers 1 through 40. The next report (M2), comprised of 30 expenditures would use sequence numbers 1 through 30. Expenditures on amended Mt reports would begin with sequence number 41 and on amended M2 reports would begin with sequence number 31. See Amendment Type instructions below. (7) Full name and address of entity receiving payment (including city, state and zip code). (8) Purpose of expenditure (if expenditure is a contribution to a candidate, also type the office sought by the candidate). PLEASE NOTE: This column does not apply to candidate expenditures, as candidates cannot contribute to other candidates from campaign funds. However, PCs (supporting candidates) and party executive committees contributing to candidates must report office sought (Section 106.07, F.S.). (9) Enter Expenditure Type using one of the following codes: I Code Descr( tion I CAN Candilate Expense I DIS Of million of Funds I DFC Disposition of Funds to Future Cargp, n (effective N/1/13) 1 DPP Disposition of Funds to Political Pony (effective 11/1/131 1 DPV Disposition of Funds to Petition Van ication (effective 11 1113) ECC Eleciloneeriry� Communication IEC Independent Expenditure Renardw a Candidate I IEI Independent Expenditure R� prdmg an Issue I MON Monelary (Not toe Candidate) I PCW Pettyy CashWithdrawn I PCs Pet(v Cash S��yyant I PPD Prepaid Disbibution I REF Refund (Negative Amount Only) +I RMB Reimbursements TOA Transfer to Office Account (Disposition of Fundsl (10) Amendment Type (required on amended reports) - To add a new (previously unreported) expenditure for the reporting period being amended, enter "ADD" in amendment type on aline with ALL of the required data. The sequence number for expenditures vMh amendment type "ADD" will start at one plus the number of expenditures in the original report. For example, amending an original 101 reports that had 75 expenditures, means the sequence number of the first expenditure having amendment type "ADD' will be 76; the second 'ADD" expenditure would have sequence number 39.