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HomeMy WebLinkAboutM4 ReportCAM AIGN TREASURER'S REPORT SUMMARY (1) J IVVj W-,4 OFFICE USE ONLY Name j .�\/j]'.JFr RECEIVED (2) "7ZZ g jFks-� MAY 10 mi dress ( umber ar/�fsbeet) zy �l 1>r� City Sebastian City Clerk's Office City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): ❑ Candidate Office Sought: ❑ Political Committee (PC) ❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded ❑ Party Executive Committee (PTY) ❑ Check here If PTY has disbanded ❑ Independent Expenditure (IE) (also covers an ❑ Check here If no other HE or EC reports will be filed individual making electioneering communications) (5) Report Identifiers ! Cover Period: From I/ 20Z/ To / 7C,/ 2/ Report Type: ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary —- Cash & Checks Expenditures $ Loans $_ ---- - Transfers to Office Account $ Total Monetary $_ Total Monetary $ In -Kind $ _ (8) Other Distributions (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 examined this report and it is We, correct, and complete: (Type name) %0YP41n P) f4Y1 ckr% ') (Type ma) �E4 OeplY TeawreaI Ie 0� ❑ Indiddal(only WIE !:Zoa rn 010 l.ftdnp wmm/.) X .YjlL X Signa''t.•llure I i Si nature DS-DE 12(Rev. 111113) 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 ff the address has changed since the last report filed. (3) ID Number. Identification number assigned by the fling officer. (4) Check the appropriate box(es). (5) Report Identifiers Cover Period: the dates this report covers (i.e., From 1/1115 To 1 1 55). Important: use the appropriate cover period dates as published by the filing officer. Report Type: refer to the filing officer's 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., 4MC ). Check one of the appropriate boxes: 0 Original: first report glad for this reporting period. 5 Amendment: must summarize only contributions/fund transfers and expendilums/distdbugons 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 amity 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. (8) 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: -- Candidate report treasurer and candidate must sign. -. PC report: treasurer and chairperson must sign. E! PTY report treasurer and chairperson must sign. U 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. TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS RECEIVED 1CAMPAIGN I.D. Number MAY 10 2021 (1) Name )yY�ry1.l \ - h t n (2) �S Illy o. o��aatian ( `V City Clerk's Office (3) Cover Period u �� —]— / Zo I 0 I through / / V I (4) Page of (5) I (7) (&) (B) (10) (1t) (12) Date Full Name (6) (Last, Suffix, Finn, Middle) Sequence Street Address& Contributor Contribution In -kind Number City, State, 7Jp Code Type Occupation Type _ _ Description ko Amount _ DS-DE 13 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Candidate's full name or name of the political committee (PC), elee6oneering communications organizations (ECO) or party executive committee (PT1). (2) The identification number assigned by the filing officer. (3) Cover period dates (e.g., 1/1115 through 1/31/151. (See filing officer's reporting dates calendar for appropriate year and cover periods.) (4) Page numbers (e.g., 1 of 31. (5) Date contribution was RECEIVED (MonthfDayNear). (6) Sequence Number— Each detail line shall have a sequence number assigned to ft. 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 amendments. For example, a M1 report having 75 contributions would use sequence numbers 1 through 75. The next report (M2), comprised of 40 contributions would use sequence numbers 1 through 40, Contributions on amended M1 reports would begin with sequence number 76 and on amended M2 reports would begin with sequence number 41. See the Amendment Type Instructions below. (7) Type full name and address of contributor (including city, state and zip code). (8) Enter the type of contributor using one of the following codes: Occupation of contributor for contributions over $100 only. (If a business. please indicate nature of business.) Individual B Business (also includes corooralions. omanizations. groups, etc.) E Eledioneerinn Communications Oroan'izations F Political Committee (federal or stale) _ P Political Parties (includes federal, state and county executive committees, O Other (e.a., candidate surplus funds to oerd. etc.) S Candidate to Sett 19) Enter Contribution Type using one of the following codes: NOTE: Cash Includes cash and cashiers checks. Code Desertption _ CAS Cash or Cashier's Check I CHE Check 1 COF Carrvover Funds from Previous Campaign I INK In -Kind j INT Interest I LOA Loan I MO Monev Order I MUC Multiple Uniform Contributions I RCT Other Receiots REF Refund (Negative Amount Onlyl I (10) Type the description of any in -kind contribution received. Candidate's Only — If In -kind contribution Is from a party executive committee and is allocable toward the contribution limits, type an "A" in this box. If contribution Is not allocable, type an "N'. (11) Amendment Type (required on amended reports) —To add a new (previously unreported) contribution for the reporting period being amended, enter "ADD' in amendment type on a line with ALL of the required data. The sequence number for contributions with amendment type *ADD" will start at one plus the number of contributions in the original report. For example, amending an original M1 report that had 75 contributions means the sequence number of the first contribution having amendment type 'ADD' will be 76; the second 'ADD' contribution would be 77, etc. When amending an original M2 report that had 40 contributions, the sWh'ADD' contribution would have sequence number 46. To correct a previously submitted contribution use the following drop/add procedure. Enter'DEL' in amendment type on a line with the sequence number of the contribution to be corrected. In combination with the report number being amended, this sequence number will identify the contribution to be dropped from your active records. On the next line enter `ADD' in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (12) Type amount of contribution received. Political Committees ONLY: Multiple uniform contributions from the same person, aggregating NMT $250 per calendar year, collected by an organization that is the affiliated sponsor of a PC, may be reported by the PC in an aggregate amount listing the number of contributors together with the amount contributed by each and the total amount contributed during the reporting period. The identity of each person making such uniform contribution must be reported to the filing officer by July 1 of each calendar year, or, in a general election year, NLT the 60th day immediately preceding the primary election. RECEIVED MAY 10 2021 City of Sebastian l CAMPAIGN TR - URER'S REPORT— ITEMIZED EXPENDITURES "" Clerk's Office n, (1)Name .�I IT) Olt Llf\� (2) I.D. Number , I (3) Cover Period // -IQ through (4) Page of (5) Date (S) Sequence Number IT) Full Name (Last, Suffix, First, Middle) Slreel Address & City, Slate, Zip Code jej Purpose (add office sought If contribution fo a candidate) tat (10) (11) Expenditure Type /vnerbmeM aunt 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 parry executive committee (PTY). (2) Identification number assigned by the filing officer. (3) Cover period dates 01( /01115 through 01131/15). (See filing officer's reporting dates calendar for appropriate cover periods.) (4) Page numbers (e.g., lof 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 Mt 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 M1 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 parry 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 Descrvion I CAN Ca��nppdiiddate Expense sition of Funds I D C Dlfspoalton of Funds to Future Carr en (effective 11/1113) I DPP Disoositon of Funds to Political Pal{v ((effective 11I1/731 DPV Disposition of Funds to Petition Ver'dica0on (effective 11 1/131 ECC EleMloneedr�p Communication I IEC Independent Dendilure Repenting a Candidate El II depryndel}{ F�PerOjlure Re�Aarding an Issue MON Monetary �Nol�lo a Candidate) PCW Petttq��Ces Withdrawn PCs Petty Lash S//yyeent PPD Pre-Deid Dislr)bution REF Refund (Nenative Amount Oniv) I RMB Reimbursements I TOA Transfer to Office Account (Disposition of Funds) (10) Amendment Type (required on amended reports) - To add a new (previously unreported) expenditure for the reporling period being amended, enter "ADD" in amendment type on a line with ALL of the required data. The sequence number for expenditures with amendment type "ADD" will start at one plus the number of expenditures In the original report. For example, amending an original Mt 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, To correct a previously submitted expenditure use the following drop/add procedure. Enter'DW in amendment type on a line with the sequence number of the expenditure to be corrected. In combination with the report number being amended, this sequence number will identify the expenditure to be dropped from your active records. On the next line enter'ADD' in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (11) Amount of expenditure.