HomeMy WebLinkAboutTR ReportCAMPAIGN TREASURER'S REPORT SUMMARY
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OFFICE USE ONLY
Name �\I
Q " C C-
-/V��
(2) %7_z_ i. li a�'_ lie, .
dress (number and strYet)
City, State, Zip Code
❑ Check here if address has changed
(3) ID Number:
(4) Check appropriate box(es):
E-yCandidate 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 / / !�
To _AL/ 2 Z / Report Type:
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $_ , _
Expenditures $ `z 3
Loans $
Transfers to
Office Account $
Total Monetary $ _
Total Monetary $
In -hind $
--
(8) Other Distributions
$ 1 1
(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. B39.13, F.S.)
I certify that I have examined this report and it is true, correct, and complete: / /� f
(Type name) f—Ore/u 8 ��Yt'(�( k4 (T�e nameU 1 "7)19'L t4 (..� i� 1 tm )
El Individual (only for IE ❑ Treasurer Deputy Treasurer [dJ Candid e ❑ chairperson (only forfPdand PTY)
or electioneering comm.)
X/�(i X
Signature Sign '
DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name J I ei1(1� ( �V�,(a/1� (2) I.D. Number
1 1�
(3) Cover Period / 0 l --Lj l ?j�Z4through L1 % / `Z 7 / _707'Z(4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In -kind
Number City, State, Zip Code Type Occupation Type Description Amendmem Amount
/
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
,,--CAMPAIGV SURER'S REPORT— ITEMIZED EXPENDITURES
(1) Name �, (YV�e V1 b� �n�x� (2) I.D. Number
(3) Cover Period {{ u / 2 N / Lhrough I/ l � i l 2dz7r— (4) Page of
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(6) (Last, Suffix, First, Middle) (add office sought If
Sequence Street Address & contribution to a Expenditure
Number City, State, Zip Code candidate) Type Amendment Amount
-77--Z
WA
DS-DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES