HomeMy WebLinkAboutElections 030521 - Recall Exploratory Committee Campaing Treasurer Report Summary (54) 4th Day PriorCAMPAIGN TREASURER'S REPORT SUMMARY
(1)
OFFICE USE ONLY
"Name
03-05-21PO4:51 RCVD
57"Af
Address (number and street)
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l . � L/S.. y tz it 3✓!U�
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City, State, 2Ip Code
❑ Check here If address has changed
(3) ID Number:
(4) Check appropriate box(es):
❑ Candidate Office Sought
T1 Political Committee (PC)
❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded
❑ Party Executive Committee (PTY) ❑ Check hem 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 „Z t
Cover Period: From / / / To
/ / u Report Type: J-/tp,4
J Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $ , 0 -
Expenditures $ �)
Loans $ , , 0 •
Transfers to
Office Account $
Total Monetary $ , , b
Total Monetary $
In -Kind $ , , -
(8) Other Distributions
$ 0
,
(9) TOTAL Monetary Contributions To Date
(10) TOTAL Monetary Expenditures To Date
$
$
(11) Certification
It Is a first degree mWiemesnorfor any person to falsify a public record (as. 839.13, F.S.)
I certify that I have examined this report and it is true, correct, and complete:
(Type nam) I JTA 4 - da? #p ry a
(Type name) J i l)lv' C / b / !v F--RS ]7` l A.,
Q ►ndiWdua► (only for E ® Treasurer ❑ Deputy Treasurer
0 It Chairperson (only for PC and PTY)
or ei onearing comm.)
,\
H
X
Signature
Signature
DSDE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
03-05-21 PO4:51 RCVD
- iTEM17ED EXPENDITURES
(2) LD. Number
(4) Page .. _ of !
(5)
Date
(7)
Full Name
(Last; Suffix, First, W iddie)
Street Address &
City, State, 23p Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
EVenditure
Type
(�0)
Amendment
(1-1)
AMOUnt
(6)
Sequence
Number
f
r
IIS-DE 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name &&1(, CI {o2 UiZ,y COH rOSE (2) I.D. Number
(3) Cover Period _22�_ / _" / �,[ through (4) Page_ of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Contributor
Type Occupation
(g)
Contribution
Type
(10)
in -kind
Description tion
(11)
Arftnftent
(12)
Amount
(6)
Sequence
Number
1 /
DS-DE 13 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES