M7 Report 08-09-2019CAMPAIGN TREASURER'S REPORT SUMMARY
(1) j gtT x4 a T
OFFICE USE ONLY
Name
(2) 713 I v r V
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rasa (number ands et)"''
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City, State, Zip Code
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❑ Check here if address has changed
(3) ID Number.
(4) Check appropriate box(es):
m
a
K Candidate Office Sought:
Z.
❑ 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 N no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From '7 1 ` 1 { To
' 1 ] 1 9 Report Type: r7
riginal ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $ ,
Expenditures $ ,
Loans $ -�4 �f% =
Transfers to
_
Office Account $ ,
Total Monetary $ ,
Total Monetary $ ,
In-Kind $
(8) Other Distributions
$ -
(9) TOTAL Monetary Contributions To Date
(10) TOTAL Monetary Expenditures To Date
$ 25w -
$
,vo
(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` andr it is true, correct, and complete:
(Type name) e k,i i
(Type name) ,p ]
❑ Individual (only for IE Ej-'Preasurer DeFFF���ty reasurer
EFem ildata ❑ Chairperson (only for PC and PTY)
or electioneering cm
/� a r
/ `
X
Signature
Signature
DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
Instructions for Campaign Treasurer's Report Summary
(1)
Name: full name of the candidate, political committee, party executive committee, electioneering
communications organization, or individual making an independent expenditure or electioneering
communication.
(2)
Address: the full address or post office box, city, state, and zip code.
❑ Check the box if the address has changed since the last report filed.
(3)
ID (dumber: identification number assigned by the filing officer.
4
Check the appropriate box(es).
(5)
Report Identifiers
Cover Period: the dates this report covers (i.e., From 111115 To 1/31155. Important: use the appropriate
cover period dates as published by the filing officer.
Report Type: refer to the filing officer's calendar of reporting dates for the correct codes to be used for
each reporting period. If report is for a special election add -S" in front of the report code (i.e., 593).
Check one of the appropriate boxes:
❑ Original: first report filed for this reporting period.
❑ Amendment: must summarize only contributionstfund transfers and expenditures/distributions being
reported as additions or deletions. Read instructions for sequence numbers and amendment types on
the back of Forms DS -DE 13A and 14A.
❑ Special Election Report: Important: once a special election report is filed, the entity is required to file all
remaining reports due for the special election.
(6)
Contributions This Report:
Cash and Checks: total amount for this reporting period.
Loans: total amount for this reporting period.
Total Monetary: sum of Cash and Checks and Loans.
In -Kind: the fair market value of the in-kind contribution at the time it is given for this reporting period.
(7)
Expenditures This Report:
Monetary Expenditures: total amount of monetary expenditures for this reporting period.
Transfers to Office Account: total amount transferred to an office account by elected candidates only.
Total Monetary: sure of Monetary Expenditures and Transfers to Office Account.
(8)
Other Distributions: the total amount of goods and services contributed to a candidate or other
committee by a PC, ECO, or PTY.
(9)
TOTAL Monetary Contributions To Date: the amount of total monetary contributions to date.
Candidates keep cumulative totals from the time the campaign depository is opened through the
termination report.
(10)
TOTAL Monetary Expenditures To Date: the amount of total monetary expenditures to date.
Candidates keep cumulative totals from the time the campaign depository is opened through the
termination report.
(11)
Type or print the required officer's name and have them sign the report:
❑ Candidate report: treasurer and candidate must sign.
❑ PC report: treasurer and chairperson must sign.
€3 PTY report. treasurer and chairperson must sign.
❑ ECO report: organization's treasurer must sign.
❑ IE or EC report: individual must sign (this applies when an individual acts alone to make these
expenditures)
AMENDMENT REPORTS: An amendment report summary should summarize only
contributions, expenditures, distributions, iii fund transfers being reported as additions or
deletions. Read the instructions for the sequence number & amendment type fields on
the back of forms DS -DE 13, 14, 14A and 94.
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name�0-r k a -,-C! �`' �" (2) I.D. Number
(3) Cover Period % 1 1 1 through 7 /_31
/ r!
(4) Page
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
CE , State Zip Code
(B)
Contributor
Type Occupation
(9)
Contribution
Type
(1t])
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
P
DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Candidate's full name or name of the political committee (PC), electioneering communications organizations
(ECO) or party executive committee (PTY).
(2) The identification number assigned by the filing officer.
(3) Cover period dates (e.g., 111115 hrough 1131115). (See filing officer's reporting dates calendar for
appropriate year and cover periods.)
(4) Page numbers (e.g., 1 of 3 ).
(5) Date contribution was RECEIVED (Month/DayNear).
(6) Sequence Number — Each detail line shall have a sequence number assigned to it. Sequence numbers
are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail
line type, and sequence number will combine to uniquely identify a specific contribution, expenditure,
distribution or fund transfer. This method of unique identification is required for responding to requests from
the filing officer and for reporting amendments.
For example, a M1 report having 75 contributions would use sequence numbers 1 through 75. The next
report (M2), comprised of 40 contributions would use sequence numbers 1 through 40. Contributions on
amended M1 reports would begin with sequence number 76 and on amended M2 reports would begin with
sequence number 41. See the Amendment Type instructions below.
(7) Type full name and address of contributor (including city, state and zip code).
(8) Enter the type of contributor using one of the following codes:
Occupation of contributor for contributions over $100 only. (If a business, please indicate nature of
business.)
I
Individual
CAS
B
Business
also includes corporations, organizations, groups, etc. I
E
Electioneering Communications Organizations
INK
F
Political Committee
federal or state
P
Political Parties
(includes federal, state and county executive
i committees
O
Other
(e.g., candidate surplus funds to party, etc.
S
Candidate to Self
REF
(9) Enter Contribution Type using one of the following codes:
NOTE: Cash includes cash and cashier's checks.
Code
Description
CAS
Cash or Cashier's Check
CHE
Check
COF
Carryover Funds from Previous Campaign
INK
in -Kind
INT
Interest
LOA
Loan
MO
Money Order
MUC
Multiple Uniform Contributions
RCT
Other Receipts
REF
Refund (Negative Amount Only)