HomeMy WebLinkAboutElections 081021 - Recall Exploratory Committee Campaing Treasurer Report Summary (62) 2021-M7CAMPAIGN TREASUREWS REPORT SUMMARY
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(1) fecAu F)C00,AIDi�/ COMH1k-E
OFFICE USE ONLY
Name
Address (number and street)
City, State, zip Code
❑ Check here if address has changed
(3) ID Number:
(4) Check appropriate box(es):
❑ Candidate Office Sought:
® Political Committee (PC)
❑ Electioneering Communications Org. (ECO)
❑ Check here if PC or ECO has disbanded
Party Executive Committee (PT1)
❑ 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 mating electioneering communications)
(6) Report Identifiers
Cover Period: From % / ! /
To E f / L l / Report Type:
® Original ❑ Amendment ❑
Special Election Report
(0) Contributions This Report
(7) Expenditures This Report
Monetary
Cash F, Checks $_ , (� . =
Expenditures $
_
Loans $_ _ , s
Transfers to
Office Account $ G .
Total Monetary $
Total Monetary $ (�
In -Kind $ d
_
(8) Other Distributions
$
(0) TOTAL Monetary Contributions To Date
NIPPON
(10) TOTAL Monetary Expenditures To Date
$. (st)
$
(11) Certification
It Is a first degree misdemeanorfor any person to falsify a public record (as. 839d3, F.S.)
I certify that 1/have examined this report and It is true,
correct, and complete:
(TYPenamek)r m /-L CRggnNc
(Typename) SILLE;C {iIIjEegST In)
❑ Individual (oniyforie RIP Treasurer ❑ Deputy Treasurer ❑ Candfdf/ddaa/�'tr� — Chatrpmon (only for PC and PTY)
or cdoneering comm.)
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x
Signature
Signature
DS-DE 12 R
( ev.11193) SEE REVERSE FOR INSTRUCTIONS
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Bate
SEE
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Buff Rene
(%as[ SUM;FIMt Middle)
3trealAddressEs
City, State, Zip Code
fst
t umose
(add OffiltcssougbtIC
contribution to a
candidate)
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McpenTrwre
Type
Anendmait
Amount
(6a
Sequence
Number
J
i
/ 1
1 1
ns_nr. an rwr..
REVERSE FOR INS Tl.UCTi0N5 AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name k Clg i l -Xp lo-p -i �Z �vnAM( fft
Y (2) I.D. Number _
(3) Cover Period J / / through 1"F / 3/ /
(4) Page of
(5) (7)
Date Full Name ($) (9) (10) (11) (12)
(6) (Last, Suffix, First, Middle)
Sequence Street Address& Contributor
Number CI , State, ZIPCode T e occu ation CoTypetion In -kind
Descri on Amendment Amount
I /
DS•DE 13 (Rev. 77/73) see KCVCRSE FOR INSTRUCTIONS AND COO6 Vat i tee