Kelly- Treasurer Report- M5- 6-12-17CAMPAIGN TREASURER'S REPORT SUMMARY
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Name
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(z)
JUN 1 2 2017
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City, State, Zip Code F-�
Office of Ciry clerk
❑ Check here if address has changed
(3) ID Number:
(4) Check appropriate box(es): /� (� (�
Se
.��-candidate Office Sought. L[)t'[�") )CB
rh1 0- 61k
LL 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 HE or EC reports will be filed
individual making electioneering communications)
(6) Report
Identifiers
Cover Period: From ! ! To
r / / I Report Type: yp
Original ❑Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $
Expenditures $
Loans $
Transfers to
Office Account $ .
Total Monetary
J
Total Monetary $ (�
In-Kind $
j
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date
(10) TOTAL Monetary Exp en(d''' res To Date
0
$ T
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
I certify that IIh�hjja��ve examined thisreportand it is true, correct,
and complete::
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44 /nI
4
(Type name) W� W v-t-
(Type name) l..11[ a u. 1�
❑ Individual (only for IE ❑ Treasurer Deputy Treasurer
XCandidate ❑ Chairperson (only for PC
or electioneering comm.)
Signature
Signature
DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name (1�1�A (2) I.D. Number
(3) Cover Period) / / I / through / / j -7 (4) Page �_ of )
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address&
City, Stale, Zip Code
(8)
Contributor
Type Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
(6)
Sequence
Number
'Ammoouuunt
DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES