Kelly- DSDE12- Treasurers Report- P7- Amendment 11-25-17 vCAMPAIGN TREASURER'S REPORT SUMMARY
L I O EVY4 ONLY
(1) l_
f
Name r
(2) 1 � q �1 NOV 2 7 2017
Addressn mber and street)
IC P_-'Fa6h
Office of City Clerk
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
C �/0� ��Im )1 �n
Candidate Office Sought: / ����n��'V ► `"��
❑ 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: From / I / To / / n Report Type:
riginal Ame� ndment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Cash & Checks $
Monetary
Expenditures $
Loans $
Transfers to
Office Account $ .
Total Monetary $
Total Monetary $� .
q�
In-Kind $
(8) Other Distributions
$
,
(9) TOTAL Monetary Contributions To Date
(10) TOTAL Monetary Expenditures To Date
$ aL
$ �,a�
(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: l
C
h kcer t�
(Type name) Ce, (\ve'l (Type name)
❑ Individual (only for IE ❑ Treasurer Deputy TreasurerCandidate [:1 Chairperson (only for PC and PTY)
or electioneering comm.)
ll -
X X L�
Signature Signature
DS -DE 12 (Rev. 11/13) JCC RCVCr[JC rur% W40 I�VV 1IVLV
(1) Name
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
("IyJace rel (2) I.D. Number
(3) Cover Period / / through / '19 /_ (4) Page of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Contributor
Type Occupation
(9)
Contribution
Type
(10)
In-kind
Descri tion
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
Nam Wb 41P 186
'I
c0I�1�60-�
n
rAct/,Y_ Vbrno
&611 R-
31\1;tzz
CKL
00QL
chor% t"Dmna
ma
& 5
Gtr
DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
C�Q►I)(1�14I IREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name ak(2) I.D. Number
(3) Cover Period 9/ G / 11 through 9/; / 1-/ (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
(1 1)
Amount
(6)
Sequence
Number
n
,01
F�°1
�Osk�
00�I�in�,ul;h
DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES