M9 - Report 10-10-22 ;;-> CAMPAIGN TREASURER'S REPORT SUMMARY
(1) (J'e_XtiSa rd W r: r vtiffEY
Name
(2) '-11 -3 AS c-J - a t-Lz' OCT 10 201:1
dress (number and street)
DyLct d t ' c , —3(-f3S CITY CLERK'S OFFICE
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Chec appropriate box(es):
r
Candidate Office Sought: ESi / � m "1"
126,S10^-t 2_r
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded
❑ Party Executive Committee(PTY) LI 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
C er Period: From ci / ._;L.:3,/ To ' / 31'1
O I Q Report Type: - -j
Original ❑Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ , , • Expenditures $ ,r)_ •
Loans $ , , • Transfers to
Office Account $
Total Monetary $ •
Total Monetary $
In-Kind $ . ,6 a, 00.
5tiK5 - Ff.(ex-.� (8) Other Distributions
$ , •
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary E nditures 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) e- cdrc,. --- tt ftlr MI'
CQ (Type name) 4Z_1—l.[(�1- Li ,---4,-,-
El
❑ Individual(only for IE ff<asurer ❑Deputy Treasurer 0 Candidate 0 Chairpers.n(only for PC and PTY)
or electioneering comm.)
f . -C-j._____.
X-'77...—i_CJA--0---R6----0 , x ra"
Signature Signature
DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name 13 (2) I.D. Number
(3) Cover Period d/ / % / through 'l / :36 / cQ (4) Page J 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 Amendment Amount
F(jC.rS
/ /
/ /
DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES