HomeMy WebLinkAboutM5 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
/ OFFICE 14 _E ONLY
Name
t ress ((number, and street) �J _ City of
.l )GsS �'C.✓\ C1 72G/� CrtYClerk, Sban
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
+i c:andidate Office Sought: (' ., t4
❑ Political Committee (PC) r
❑ 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 IE or EC reports will be filed
individual making electioneering communications) p
(5) Report Identifiers yi
Cover Period: From To S / S % / 7 Report Type:
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ S v Expenditures g
Loans $_ • _ Transfers to
Office Account $
Total Monetary
Total Monetary $
In -Kind $ _
(6) Other Distributions
$ ,
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ 750 $
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
I certify that i have examined this report and itl iis,1 true, correct, and complete:
(Type name) _ �GY(j !'i ! ) �:'1�Q ° uvl (Type name) U %n /j}-7
❑ Individual (only for IE [ ,Treasurer [-IDq ly Treasurer [ICandidate ❑ h rson (only for PC Jbd Trlo
or electioneering comm.)
X X
Signature Signature
DS-DE 12 (Rev. 11113) E REVERSE FOR INSTRUCTIONS
R
CAMPAIGN THE URER'S REPORT - ITEMIZED CONTRIBUTIONS ✓�/,0/�c��VFO
C%r 8
(1) Name J ftilVVIV/ l (i � (2) I.D. Number lCi�seb <i
(3) Cover Period / , I through / / (4) Page of
�e
(5) (7) (6) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address& Ccntributor Contribution In -kind
Number Citv, State, Zip Code Type Occupation Type Description Amendment Amount
S / 1 Z / -7-�'
7ZZ
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
AMPAIG TR UREE�' REPORT —ITEMIZED EXPENDITURES
(1) Name �\ \MM "i v ` (2) I.D. Number
(3) Cover Period /J_/ through S /—(4) Page
(5) (7) (8) (9)
Date Full Name
(8) (Last, Suffix, First, Middle)
Sequence Street Address &
Number City, State, Zip Code
DS-DE 14 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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