M12 Report 01-10-2022CAMPAIGN TREASURER'S REPORT SUMMARY
(1) I acr d0.fX-.P_11_
OFFICE USE ONLY
Name
(2) -510
jAkit0 '::21x13Ptl
Address (number and street) r
C T. TY �•;LE.FiX
S�
-e�A
_
City, State, Zip Code
i "�'� `EI"H
❑ Check here if address has changed
(3) ID Number:
(4) Check appropriate box(es):
�6t�
❑ Candidate Office Sought: Y1^
'rt 1�Y! I'i'( L.SS M,
❑ 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 l I To
/01- / 3! 1 Report Type:
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $ , (000 C
Expenditures $
Loans $
Transfers to
Office Account $
Total Monetary $ ,
Total Monetary $ .
In-Kind $ f
(8) Other Distributions
$ , ,
(9) TOTAL Monetary Contributions To Date
(10) TOTAL Monetary Expenditures To Date
$ 0•o
$
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
I certify that Ifhayv�e examined report and it is true, correct, and complete:
jthis
(Type name) fi I IL I �r w11� . r..
(Type name) n� � p•� �-
❑ Individual (only for IE 0- reasurer ❑ Deputy Treasurer
D Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X
X�
Signature
Signature
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name Mt� Wd _ (2) I.D. Number
(3) Cover Period )oI -- I I through / / (4) Page of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
Cit , State, Zip Code
(8)
Contributor
Occupation
(9)
Contribution
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
All�aL
W1, urm, V, 341,
—Type
LType
/
/110
tOlbr� �
'01�
�
boo 1 GGAAJ1 &eA
2
3a t%3
DS -DE 13 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
MPAJGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name ," (2) I.D. Number
(3) Cover Period �"I / I / ,V through P 13 / l � (4) Page r 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
(1 0)
Amendment
(11)
Amount
(6)
Sequence
Number
Id- 13
2lug s� A �
r✓� . -12- 3333
, �� s ►�
AJ v l
fig
11 A1W l
3cC� n, X432
cry t,
2—
DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES