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Hall- DSDE 12- Treasurer Report 6-8-17
4)", it r1 -C'. CAMPAIGN REPORT SUMMARY rT=ER'S (1) M(�Iyly OFR6£9R841bNLY Name (2) (Q8 S [3 =P -50'd< �. f JUN 8 2017 Address (number a d street) rF��-Ihn�I c N, R, 3 ZZ3 3 City, State, Zip Code Office of city Clerk ❑ Check here if address has changed (3) ID Number: 41 (4) Check appropriate box(es): TtCandidate 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 Iden ' iers Cover Period: From / / (7 To ll /31 3 / [? ReportType: /A'5 Arigmal ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report r Monetary `�� t� Expenditures Cash & Checks $_ p�7 $ y Loans $ © 00 Transfers to Q� Office Account $ . Total Monetary $ ' Total Monetary $ 0 C� O In -Kind $ (8) Other Distributions 00 $ (9) TOTAL Monetary Contrib'uti9he To�ate (10) TOTAL Monetary Expenditures Tq Date 1:9 Cl ri �s �C $ (11) Certification It is a first degree misdemeanor for any penton 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) N((,.t t* �y �- / (Type name) (�C%A ❑ Ind -,dual (only for IE Treasurer Depo Treasurer Candidate ❑ Chairperson (only for and PTV) or electioneering comm.) (�\� x� x Signature Signature DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name AA( (_,y f '}�Clf� t� `4AtL— (2) I.D. Number (3) Cover Period 15� / J_ / through C/ 3_ / l-7 (q) Page of 1 (8) Dale (T) Full Name (Last, Suffix, First, Middle) Street Address& Cit StateZi Cod (8) Contributor T e Ocou ation (9) Contribution T e (10) In-kind Descri lion (11) nmenameni (12) Amount (6) Sequence NW- �S'eNl3t'1Q)�CK � 5NI DS -DE 13 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES