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CAMPAIGN TREASURER'S REPORT SUMMARY
OFFICE USE ONLY
NamA
(2) i / c' n i ) S (
Address (number and street)
City, State, Zip Code
❑ Check here if address has changed (3) ID Number: UfFQe
(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 IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
?Cover Period: From lY / ( / To ( I / Report Type:
ql-briginal ❑ 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
$ 11
(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 (ss. $39.13, F.S.)
I certify that I have examined this report and it is true, correct, and complete: en
(Type name) �i CI( V" '-'L\ � t i e{G'ii� (Type name) S'C�& u, (CeUN 67t ((( Cq &,LL
(])Individual (only for IE 0 Tre�ufer ❑ Deputy Treasurer )� Candidate Cha arson (only for PC and PTY)
,or electioneering Co )
I
X x,
Signature Signature
DS-DE 12 (Rev. 11N3) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
f a
(1) Name 1/A(4P�t � ��� f 16tit4A5 (2) I.D. Number .l of y
(3) Cover Period through - / / { (4) Page l of
e
(5) (7) (6) (g) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address& Contributor Contribution In -kind
Number City. State, Zip Code Tyne Occupation Type Description AmeMmmN Amount
DS-DE 13 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREA RER',S REPpRT— ITEMIZED EXPENDITURES
(1) Name ��?CL'1%1 / (2) I.D. Number
(3) Cover Period I (L / 1 throdgh �� / (L l �I (4) Page of
(5)
(7)
Date
Full Name
(6)
(Last, Suffix, First, Middle)
Sequence
I
Street Address &
Number
City, State, Zip Code
Vie)
Purpose
(add office sought if
contribution to a
candidate)
juj j10) (11)
Expenditure
Type Amendment Amount
DS-DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES