G3 10/08/11 to 10/27/11 Campaign Treasurer's Reporti
FLORIDA DEPARTMENT OF STATE DIVISION OF �We7T OFA \1 F n
CAMPAIGN'TREASURER'S REPORT SUMMARY
(1) Citizen Action,Inc. u Y
Name CITY CLF Rii'S OFFICE
(2) 7525 SW 54th Ct
Address(number and street)
Miami,FL 33143
City, State,Zip Code
❑ Check box if address has changed (3) I.D.Number: 55388
(4) Check appropriate box(es):
Candidate(office sought):
Political Committee ❑ Check if PC has DISBANDED
Committee of Continuous Existence
❑ Check if CCE has DISBANDED
Party Executive Committee
X Electioneering Communication ❑ Check if no other electioneering communication reports will be filed
(5) REPORT IDENTIFIERS
Cover Period: From 10/08/2011 To 10/27/2011 Report Type: G3
❑X Original ❑Amendment ❑ Special Election Report ❑ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash&Checks $75,000.00 Expenditures $65,861.00
Transfers to Office
Loans $0.00 Account $0.00
$75,000.00 $65,861.00
Total Monetary Total Monetary
In-Kind $0.00 (8)Other Distributions $0.00
(9) TOTAL Monetary Contributions to Date (10) TOTAL Monetary Expenditures to Date
$136500.00 $101,517.40
(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 I certify that I have examined this report and it is
true,correct and complete true,correct and complete
Keith Donner Keith Donner
❑ Individual(only for Treasurer ❑ Deputy Treasurer ❑ Candidate Chairman(only for PC,PTY&
electioneering X{ X( electioneering commun.organization)
commu .)
X V, X
Signat re Signature
This form is based on DS-DE 12(Rev.08/04) Adjutant Software,Inc.-Campaign ToolBox
0
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Citizen Action, Inc. (2) I.D. Number 55388
(3)Cover Period 10/08/2011 - 10/27/2011 (4) Page 2 of 2
(5) (7) (8) (9) (10) (11)
Date
Full Name
(6) (Last,Suffix,First,Middle) Purpose
Sequence Street Address& (add office sought if Expenditure
Number City,State,Zip Code contribution to a candidate) Type Amendment Amount
10/20/2011 Wells Fargo Bank fees MON $156.00
1541 Sunset Dr
Coral Gables, FL 33143-0000
9
10/21/2011 America CV Network Advertising MON $8925.00
13001 NW 107th Ave
Hialeah Gardens, FL 33018-0000
10
10/26/2011 America CV Network Advertising MON $ 1700.00
13001 NW 107th Ave
Hialeah Gardens, FL 33018-0000
11
This form is based on DS-DE 14(Rev.08/03) Adjutant Softwar/e,Inc.-Campaign ToolBox I L
CAMPAIGN TREASURER'S REPORT- ITEMIZED DISTRIBUTIONS
(1) Name Citizen Action, Inc. (2) I.D. Number 55388
(3)Cover Period 10/08/2011 -10/27/2011 (4) Page 0 of 0
(5) (7) (8) (9) (10) (11)
Date
Full Name
(6) (Last,Suffix,First,Middle) Purpose
Sequence Street Address& (add office sought it Related
Number City,State,Zip Code contribution to a candidate) Expenditures Amendmenl Amount
Nothing to report on this form
This form is based on DS-DE 14A(Rev.08/03)[Note about Committees has been removed.] Adjutant Software,Inc.-Campaign ToolBox
/ '^�
CAMPAIGN TREASURER'S REPORT - FUND TRANSFERS
(1) Name Citizen Action, Inc. (2) I.D. Number 55388
(3)Cover Period 10/08/2011 - 10/27/2011 (4) Page 0 of 0
(5) (7) (8) (9) (10) (11)
Date
Name of Financial
(6) Institution Transfer Nature of
Sequence Street Address 8
Number City,State,Zip Code Type Account Amendmeni Amount
Nothing to report on this for
This form is based on DS-DE 94(Rev.08/03) Adjutant Software,Inc.-Campaign ToolBox
/ n
�Y '
(0