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(4)
CAMPAIGN TREASURER'S REPORT SUMMARY
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OFFICE USE ONLY
Names
Addr ss (numb r and street)
71C);� �� �? ')9s�
City, State, Zip Code
❑ Check here if address has changed
(3) ID Number:
OrT _
Sega
"y C
C,��he,�cck appropriate box(es). / l / / J
�t;andidate Office Sought: �� (n ? S 7 1 � ti C. /
❑ 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 w / / 9 To ID l f l Report Type:
LyfOriginal ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $_ 1_ 1 0on
-
Loans
Total Monetary
In -Kind
(9) TOTAL Monetary Contributions To Date
(7) Expenditures This Report
Monetary
Expenditures $ 0(
Transfers to
Office Account $
Total Monetary $
(8) Other Distributions
$
(10) TOTAL Monetary Expenditures To Date
$ Cn
(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
rthis report and itis true, correct, and complete: 91,
//(Type name) / J b N f r c. / ,A ✓ !r '` >, (TYPe name) ) / (qua 9 N'4 l ce n
❑ Individual (only for IE B'Treasurer ❑ Deputy Treasurer (Kandidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.) J
Signature Signature
DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
R
CAMPAIGN TREASURER'S REPORT
— ITEMIZED
CONTRIBUTIONS
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An /q
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(1) Name
(2)
I.D. Number
Cover Period
ID
l
r-
°e
(3)
(
/) / / through /
/
(4) Page
of
(5)
1 (7) (8)
(9)
(10)
(11) (12)
Date
Full Name
(5)
(Last, Suffix, First, Middle)
Sequence
Street Address& Contributor
Contribution
In-kind
Number
City, State, Zip Code Tvpe
I Occupation
Type
Description
Amendment Amount
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
��"
C MPAIG�j TREASURER'S REPORT - ITEMIZED EXPENDITURE*Q1>
(1) Name 1 ) V� Y s i to n (2) I.D. Numbers. /i- . �n
/ hofs ,r4®
(3) Cover Period 10 /�through /0 7 / (4) Page "-of"fo
it (5) (T) (g) (9) (10) (11)
Date Full Name Purpose
(6) (Last, Suffix, First, Middle) (add office sought if p Ex enditure
Street Address & contribution to a
Sequence City, State, Zip Code candidate) Type Amendment Amount
Number
DS -DE 14 (Rev. 11113)
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SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES