M12 Report 01-10-2022CAMPAIGN TREASURER'S REPORT SUMMARY
(1) �� . ��S%!T( OFFICE USE ONLY
T
Name
(2) 1 3 r- / ,V 24� WkAl J)'0N :i O 22 4.14 "M
Address (number and street) / y t CITY CLEAR
Bft'1170N BEACH
City, State, Zip Code
❑ Check here if address has changed (3) ID Number: /Li
(4) Check appropriate box(es):
iCandidate Office Sought: d����i"'7rU (/✓rn�cz,�sT�//t[S� f
❑ 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 / / W2J To 1 -�/ / / qd�,j Report Type:
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $ f4 U . UU
Expenditures $ 2
Loans $ t t Iyc 06
Transfers to
Office Account $ ,
OU
Total Monetary $ d 0
Total Monetary $ .
In -Kind $
(8) Other Distributions
$ t
(9) TOTAL Monetary Contributions To Date
(10) TOTAL Monetary Expenditures To Date
$ �,�o
$
.Gy
, .-77
(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) %IUIs �' (?ti y7 ..e (Type name) l k / S r G, TiI
❑ Individual (only for IE ❑ Treasurer Deputy Treasurer Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X X
C�
Signature Signature
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT —ITEMIZED EXPENDITURES
(1) Name (�S �U _ _ (2) I.D. Number
(3) Cover Period 11— / 1 through IZI / 3/ /92j (4) Page of
(5)
Date
I
(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
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1
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12 13
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DS -DE 14 (Rev 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES