M11 Report 12-10-2019CAMPAIGN TREASURER'S REPORT SUMMARY
(1)
OFFICE USE ONLY
Name
(2)
Address (numb r and street)
City, S ate, Zip Code
:
❑ Check here if address has changed
(3) ID Number:
(4) Check appropriate box(es):
-'?
Ei/candidate Office Sought: .,,`�S.�.y.a / 1��t1�`� �{ a4„
❑ Political Committee (PC)
� �
0—
❑ 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 (( / p t / f To
it / j o / r f Report Type: 20l-7 A411
Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $ ,Z, b so co --
Expenditures $ ,
Loans $
Transfers to
Office Account $
Total Monetary $ ad
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 this report and it is true, correct, and complete:
�.
(Type name) t `3 i'��Stl'ls�./9
(Type name) f'
❑ Individual (only for IE Treasurer ❑ Deputy Treasurer
Candidat ai rson (on r PC and PTY)
or electioneering comm.))
G
X
X
Signature
Signature
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name
y P�-NS6??4,4
(2) I.D. Number
(3) Cover Period if / p ( / 14
through t) /
3o l (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
I Amendment Amount
PJAL be" Cv_on
Il / I</
4 ?.&C get V'jQ.4
�- CIE, PA
F
Coo
(
2,1 00 N -1
R. W abt , 3007
1
4. 4eaa& cov
C. x5w"r �.�
g
Law
Clam'
3
33{t3 �
DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name ,--.CAMPAIGN
�a�se721,�? (2) I.D. Number
(3) Cover Period 11 / 01 / 17 through 11 /_J?o / (4) Page 1 of
F5)
Date
(7) (8)
Full Name Purpose
(Last, Suffix, First, Middle) (add office sought if
Street Address & I contribution to a
City, State, Zip Code candidate)
(9)
Expenditure
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
1 I
tot
DS -DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES