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HomeMy WebLinkAboutG3 ReportCAMIPAIGN TREASURER'S REPORT SUMMARY J fOFFICE USE ONLY Name (2) �yyJtr FJ Addressnumber and street ` /( j)' -, Cif G S / S C iy of .0eb City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): / 1 tldG`ec/andidate Office Sought ❑ Political Committee (PC) ❑ Electioneering Communications Org. (ECO) ❑ Party Executive Committee (PTY) ❑ Independent Expenditure (IE) (also covers an individual making electioneering communications) ❑ Check here if PC or ECO has disbanded ❑ Check here if PTY has disbanded ❑ Check here if no other IE or EC reports will be filed (5) Report Identifiers Cover Period: From /o/ / % To �(� / '� / / C% Report Type: Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ _ , �©. Expenditures $— Loans $_ , _ Transfers to Office Account $ , Total Monetary $ , _ , 700 . _. Total Monetary $ In -Kind $ (8) Other Distributions (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. 839.13, F.S.) I certify that I have examined /t�lhis r ort/an/d/ it is true, correct, and complete: y//I (Type name) I\ /llc. q f- "r 17 rti. (Type name) � � A� X h ❑ Individual (only for IE Ird-i reasurer ❑ Deputy Treasurer IiCendidate ❑ Chairperson (only for PC and PTY) or electioneJeri���m.)�+///J IW Signature Signature DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS R CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS FC�iL� (1) Name da C c �9 f �q n (2) I.D. Number asf� (3) Cover Period through (4) Page of (5) (7) (8) Date Full Name (6) (Last, Suffix, First, Middle) (9) (10) (11) (12) Sequence Street Address& Contributor Contribution In-kind Number I City, State, Zip Code Type I Occupation Type Description Amendment /D, 30, /9 K,ry��- t84 .7t 40'( h F/w►fil 16e2as (�W//yry1 _"A C Id , 3) , l 9 10 �- k3156 7"L S4 Kfo tp 2a96? f DS -DE 13 (Rev. 11113) Amount j00.00 Soo, oo SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES io/20/l9 USPS i 3,190// rlI i,/ SI IdW f DS -DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 3so.do �iL CAMPAIGN REAy�Ul2ER'S REPORT - ITEMIZED EXPENDITUFka, (1) Name /,` n �� r y /� n (2) I.D. Number o (3) Cover Period /0/ through / /� 31 % / p (4) Page `o6tit,-b' (5) (2) (8) (g) (10) 00 (11) Date Full Name Purpose (6) (Last, Suffix, First, Middle) (add office sought if Sequence Street Address & contribution to a Expenditure Niimhar City, State, Zip Code candidate) Type Amendment Amount io/20/l9 USPS i 3,190// rlI i,/ SI IdW f DS -DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 3so.do