DS-DE 12 G1-11 Levey FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
( Laura Rivero Levey R FrO9N.
Name
(2) 4777 Pinetree Drive 2011 SEP 30 PM 5; 00
Address (number and street)
CITY CL i 'S OFFICE:
Miami Beach, FL 33140
City, State, Zip Code
n CHECK IF ADDRESS HAS CHANGED (3) ID Number:
(4) Check appropriate box(es): f44 F 1 Candidate (office sought): 1-7 ' DOIl� (
n � Political Committee CHECK IF PC HAS I SBANDED
❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED
❑ Party Executive Committee
4 r Electioneering Communication J CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS
Cover Period: From 07 / 01 / 2011 To 09 / 23 / 2011 Report Type G1 -11
• ✓I Original [ Amendment n Special Election Report n Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ 2,500.00 Expenditures $ 1,360.00
Loans $ Transfers to Office
Account $
Total Monetary $ 2,500.00 Total
Monetary $ 1,360.00
In -Kind $
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ 2,500.00 $ 1,360.00
(11) CERTIFICATION
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
certify that I have examined this report and it is true, I certify that I have examined this report and it is true,
correct, and complete. correct, and complete.
(Type name) Laura Rivero Levey (Type name) Laura Rivero levey
:Individual (only for ❑ Treasurer Deputy Treasurer • Candidate ❑ Chairperson (only for PC, PTY &
electioneering un ) ing commun. organization)
A electione
-
Signature Signature
DS -DE 12 (Rev. 08/04)
1
3
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Laura Rivero levey (2) I.D. Number
_ (3) Cover Period 07 / 01 / 2011 through 09 / 23 / 2011 (4) Page 1 of 1
(5) (7) (8) (9) (10) (11) ( 12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In -kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
1500.00
Laura Rivero levey I e
AS
09 / 09 /2011 4777 Pinetree
Drive
Miami Beach, Fl
60 / l 33140
947 Lincoln RD B CHE 500.00
09 08 011 Investment, Inc.
940 Lincoln RD
1 .,„ L • Stuite 301
115 Miami Beach, 33139
Bahmaneh I
CHE 500.00
09 / 08 2pll Deralshani Yazdani
L -L
Uo3
1
1
1
DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
d,,,, e- i(---- 3
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Laura Rivero levey (2) I.D. Number
(3) Cover Period 07 01 2011 through 09 23 2011 (4) Page / of
(5) (7) ( (9) ( (
Date Full Name Purpose
(Last, Suffix, First, Middle) (add office sought if
(6) Street Address & contribution to a Expenditure
Sequence Type
Number City, State, Zip Code candidate) Amendment Amount
L � L Miami Beach City Hall IBS $1,360.00
09 / .9 / 11 L L
00, .z, (z /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS -DE 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
PA 4' 3
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