HomeMy WebLinkAboutM9 Report AmendedREASURER'S REPORT SUMMARY
CAMPAIGN TREASURER'S
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OFFICE USE ONLY
Name
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RECEIV�p
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Address (nu t(er and street)
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CItyOf 3
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City, State, Zip Code
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❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es): /
('Candidate Office Sought: co &1 C t
❑ 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 � I % I .,Z� 70 �Q Report Type: /'y?p /
❑ Original Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $_
Loans $_
Total Monetary $_ 1 1_ •
In -Kind $ 3 019• !0
(9) TOTAL Monetary Contributions To Date
S 7A
(7) Expenditures This Report
Monetary
Expenditures $ ( q ern
Transfers to
Office Account $
Total Monetary $
(8) Other Distributions
$ 1 Q 01-0
(10) TOTAL Monetary Expenditures To Date
$ 2 _2�?
(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 it is true, correct, and complete: f
(Type name) l v(yYrr/�s W ` �r 4/'4',. (Type naC1lrcn
/S /./vl N/1l
❑ Individual (only for IE ❑ Treasurer ❑ Deputy Treasurer Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm )
Signature ure
DS•DE 12 (Rev. 1ill 3) SEE REVERSE FOR INSTRUCTIONS
t �ZZQ IED
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONSC
(1) Name CU`t^'S�bP �t e t (2) I.D. Number I ;r
(3) Cover Period f + / I Z It through �. I G/ 2 (4) Page I of
(5) (7) (S) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address& C:mtributor Contribution In -kind
Number Citv. State, 7jD Code TvDe Occupation Type Description Amon&m° Amount
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DS-DE 13 (Rev, 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES