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G3 Report
CAMPAIGN TREASURER'S REPORT SUMMARY (1) Cjk r l IAO�VI �y 0 Ai V OFFICE USE ONLY Name (2) '7 0 4 T©t--� r -K) +v-2 Address (number and street)[ t� of �0>4 City, State, Zip Code C/erkebnstieo ❑ Check here if address has changed (3) ID Number: �o (4) Check appropriate box(es): Candidate Office Sought: /� C , Y L ©G r0 G I / ❑ 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 IE or EC reports will be filed individual making electioneering communications) Cover Period: From /O / /& / M Original ❑ Amendment (6) Contributions This Report Cash & Checks $_ , , (5) Report Identifiers r To /a / 2 g- / Report Type: C� ❑ Special Election Report (7) Expenditures This Report Monetary Q . 66 Expenditures $ _ , _ , _ ) , Loans $_ , _ , p--rO Total Monetary $_ , _ , © ?) In -Kind $ (F% O-D (9) TOTAL Monetary Contributions To Date $ 7, Transfers to Office Account $ d Total Monetary $ �j , �c) (8) Other Distributions $ 1 1 0 . C) � (10) TOTAL Monetary Expenditures To Date $ , i z -57 (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 an" is true, correct, and complete: (Type name) C9ZSRti C.P (Type name)0,#X /> /� 0 P11 // 2 'Az'i% AIV✓ ❑ Individual (only for IE ❑ Treasurer ❑ Deputy Treasurer Candidate ❑ Chalrperson (only for PC and PTY) or electioneerin comm.) V X ) Ater 6. X Signature Si lure DS-DE 12 (Rev.11113) SEE REVERSE FOR INSTRUCTIONS