M11 Report 12-01-2021CAMPAIGN TREASURER'S REPORT SUMMARY
P 641,7,Te
OFFICE USE ONLY
(1)
Name
(2) f3 5W a S' th wt//
Address (number and street)
&d�?fto /'g 4,i, ,
City, State, Zip Code
❑ Check here if address has changed
(3) ID Number:
(4) Check appropriate box(es):
❑ Candidate Office Sought: 4)/-A*4 /vette
❑ 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: Fromt / To
� ( / p / 2&V Report Type: ��
❑ Original El Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $ CU 00
Expenditures $
Loans $
Transfers to
Office Account $
Total Monetary $ , � i) t3
Total Monetary $ ,
In -Kind $ > (�
(8) Other Distributions
$ , ,
(9) TOTAL Monetary Contributions To Date
�, vs
(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) ii2s �O�R/1
(Type name)
Individual (only for IE ❑ Treasurer Deputy Treasurer
f(Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X -✓
X % f
Signature
Signature
DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASTER'S REPORT — ITEMIZED EXPENDITURES
(1) Name 1h6pw S �� /4417 f �1(2) I.D. Number
(3) Cover Period I / / I / )-04 through �� / �� 12-0-11 (4) Page of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Expenditure
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
I �
150;4 t �/ ft L,4
j f114� f
d!�
I I
DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES