Kelly- Treasurer Report- P5- 8-11-17 - vCAMPAIGN TREASURER'S REPORT SUMMARY
OFFI%USE OILY
(ia
(1) n�V�� 1 ecelve
(2) N qe-6:
�rse and s reet)� 2��AUG 1 1 2017
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City, State, Zip Code Office of City Clerk
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
(UI}iVU� G�iV
Candidate Office Sought: VI
❑ 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: FromZ / / To / / Report Type:
fL
-r+
Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Cash & Checks $
Monetary
Expenditures $
Loans $ QJ
Transfers to
Office Account $
Total Monetary $ > � 0D
Total Monetary $ !�
In-Kind $ > 4L
.
(8) Other Distributions
$
5�
(9) TOTAL Monetary Contributions To Date
$
(10) TOTAL Monetary Expenditures To Date
$ P
(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) (,��{C,� 411 �/ (Ty e name) CO
❑ Individual (only for IE ❑ Treasurer Deputy Treasurer Candidate ❑ Chairperson (only for'PC and PTY)
or electioneering comm.)
X ct 1 X L jo�j
s
Signature Signature
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Gon�� A 4 (2) I.D. Number
(3) Cover Period /�/ through �j (4) Page
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
CitX, State, Zip Code
(8)
Contributor
Type Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
I
-56
r7
A 40 NP
DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
) C,��CAMPAIGN ,1;�REASURER'S REPORT- ITEMIZED EXPENDITURES
(
1 Name lJ �tJ �) (2) I.D. Number
(3) Cover Period/through// (4) Page of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Expenditure
Type
(1 0)
Amendment
(11)
Amount
(6)
Sequence
Number
7L31 z n.
d
-c-,rvace�'�614111
��
�I
mb
C�
DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES