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CAMPAIGN TREASURER'S REPORT SUMMARY �`�EIVEp
)---..�
Name
Address (number and street)
S4-Z13a:ZaP,J 3275;8'
City, State, Zip odC e
❑ Check here If address has changed
Check appropriate box(es):
OFFICE USE ONLY' 8 20?
City of
Cit, rl� kebasti.
s OffiC_
(3) ID Number:
EXCandidate Office Sought: CIklO-gQm(-I L t1 4aw0 W ti) c( 1'0-Wt�
❑ 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 9 ! (� / ZLZ5 To C / 19 / ±, ReportType:
Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $_ _ , ) • �Q Expenditures $ _ , d • Ly
Loans $_,_,�•�%
Total Monetary $_ , _ , t�-> • 'Do
In -Kind $_ _ , Q • 06
(9) TOTAL Monetary Contributions To Date
$ _, O. ov
Transfers to
Office Account $ o p
Total Monetary $ _ D U
(8) Other Distributions
$ ,
.(10) TOTAL Monetary Expenditures To Date
$ C7 . no
(11) Certiticatlon
It is a first degree misdemeanor for any person to falsify a public record (as. 839.13, F.S.)
I certify that I have examined this report and it Is true, correct, and complete: y�
(Type name)AC /irC671A/A/ (Typename)
❑ Individual (wVor IE XTreasurer ❑ Deputy Treasurer PlCsndidats ❑ ChalTemon (o*for PC end PTY)
or elecf awing comm.) /J ,('I�]/ �.
X A, a-rpi�`7./ YYl G /Mv� X
Sig ture / Signature
DS-0t 12 (Rev. 11l13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT —ITEMIZED CONTRIBUTIONS
(1) Name
TG,ePlOt�� A-1 t
(2) I.D. Number
(3) Cover Period ! to l Zv25 through Q l
_Z 7 1 ? (4) Page
of
(5)
(7) (8)
(9) (10) (11)
(12)
Date
Full Name
(6)
(Last, Suffix, First, Middle)
Sequence
Street Address & Contributor
Contribution In-ldnd
Number
City, Stale, z10 Code Type Occupation
Type Descdollon Amnd=nt
Amount
0fJ �7
DAl
0, DO
Sep9'„F��Fo
c, 0'-
�jPr�sbq�t/d
0- h
ce
DS-DE 13 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name 7�-PORx`- 4 /{ilk/n/N (2) I.D. Number
I(3) Cover Period 6_/lZ through Q ? (4) Page 3 of
Date Full Name Purpose
(g) (fast Suffix, First Middle) (add office sought if
Sequence Street Address S contribution to a Expenditure
Number CRY, State, Zip Code candidate) Type AmendmentAmount
WA
/ I
/ 1
DS-DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES