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M9 Report 10-10-2019
CAMPAIGN TREASURER'S REPORT SUMMARY -� - OFFICE USE ONLY = - Name Address (number and street) ' City, te, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): , 916andidate Office Sought: ❑ 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: FromTo / `,b I �--k-- Report Type: j Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ (?x:1'9 Expenditures $ , , Loans $ Transfers to Office Account $ , Total Monetary $ , Total Monetary $ , In-Kind $ , (8) Other Distributions $ , (9) T 0—Ti AL Monetary Contributions To Date (1o) T ;TAS 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) .. ' L t 11� P (Type name) fl ❑ Individual (only for 1 Treas r © Deputy asurer ndidate ❑ Chairperson (only for VIC and PTY) or electioneering m.) e X X Signature Signature DS -DE 12 (Rev. 11/13) \IJ SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name i'�ls�t�+ �--Q �/�,"� (2) I.D. Number (3) Cover Period / / through / 3U / (4) Page & (5) (7) (8) (9) (10) (11) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In-kind Number Ci ,State Zi Code T e {�Occu ation T e Description Amendment Amount I I 1 1 I / DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES