HomeMy WebLinkAboutG1 ReportCAMPAIGN TREASURER'S REPORT SUMMARY
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(1) �cZinniet� C71�lialnt>
OFFICE �jLY
Ep
Name
Address (number and street) Q
FL , % ��/
City of
CitYCleks 'ebaiu'an
City, State, Zip Code
❑ Cheek here if address has changed
(3) ID Number
(4) Check appropriate box(es): _
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I OVV1 C I
(,9Candidate Office Sought
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO)
❑ Check here if PC or ECO has disbanded
❑ Party Executive Committee (PTY)
❑ Check here N PTY has disbanded
❑ Check here If no other IE or EC reports will be filed
❑ Inde M f IE) (also covers an
individual J}rd(cing el ctioneenng communications)
A RejW1( Identitiere
Cover Period: From / / L2 To L / f "ZZ ReportType: UT1
MOn"I ❑ Amendment ❑ SpeGal Election Rgi
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $_ Expenditures $ } _ , — • _
Loans $ n �� Transfers to r,
Office Account $
Total Monetary—�
Total Monetary $
In -Kind $ _ ' _
(8) Other Distributions
$
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ — -- �i)U o� $ �I
(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 We, correct, and completed I
(Type name) ' %CA uo i-e 6/1 I � ('a l2( ( (Type name) (-L� IM i Q I/� I� 1 It q /�U 5 —
❑ kKk%kW (only for IE 0 Treasure ❑ Deputy Tree canaaau iJ Chiikpeon (o,+y tar PC and Fit
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x x
Signature Signat a _
DS-DE 12 (Rev. IIM3) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
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(1) Name 17 l�iWl (2) I.D. Number
ii C. r
(3) Cover Period L / ! I Z Z 9.gh � / 7 / s. 0) Pape of
(5) m (el (9) (+e) l++) (12)
Date FuH Name
(a) (Loal Suifm FYU. MidAe)
sequence Soset Addreee8-cdnUihvtor ContrbWoe h.«ina A ,),� \ �pn��l
Number ckv. state. Do Code Tvae TC,V � DeodOe - ante ,
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EE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN THE SURER'S REPORT— ITEMIZED EXPENDITURES
RN/t11,II,\\v1 �N%it G (2)I.D. Number
(J)CowPedod W/ i /� rough l U /-/,2L (4)Page.�of
(7) 14 (e)
Full Name Purpose
(last. Suffix, First, Wddfe) (add oglos owght If
Straw Add=& & wnbibut$on to a
CIr. all* ZIP Code undW.t�•
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(a) (tt)
Expandlture
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SEE REVERSE FOR DISTRUC HM AND CODE VAWEE