DS-DE 12 Miami Beach Advisory Council M5 CAMPAIGN TREASURER'S REPORT SVIVIMA:RY
(1) Miami Beach Advisory Council 2015 -6, it9E
Name 2015 jLIN c49: (VI
CITY Ci S L.11-
(2) 2618 Centennial Place CITY CL L-! c; S OFFICE
Address (number and street)
Tallahassee, FL 32308
City, State, Zip Code
El Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
El Candidate Office Sought:
El Political Committee(PC)
SI Electioneering Communications Org. (ECO) ID Check here if PC or ECO has disbanded
ID Party Executive Committee(PTY) El Check here if PTY has disbanded
DI Independent Expenditure(IE) (also covers an p Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 05 / 01 / 15 To 05 / 31 / 15 Report Type: MO5
SI Original El Amendment 1:1 Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks , 750 . 00 Expenditures $ 120. 00
Loans $ , Transfers to
Office Account $ •
Total Monetary , 750. 00
Total Monetary $ , 3 120 . 00
In-Kind
(8) Other Distributions
$ ,
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
15, 000 . 00 10 , 620 . 00
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
I certify that have examined this report and it is true, correct, and complete:
(Type name ark H .on (Type name)
Individual onl, .r IE 2 I easurer 0 Deputy Treasurer 0 Candidate 0 Chairperson(only for PC and PTY)
or electione, ing co .)
X X
Signature Signature
DS-DE 12(Rev. 1/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS
Miami Beach Advisory Council
(1) Name (2) I.D. Number
05 01 15 05 31 15 1
(3) Cover Period / / through / / (4) Page of
(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
R2 Innovations, LLC
05 19 15 56 Pinehill Trl E
Tequesta, FL 33469
B Real Estate Check $750.00
1
/ /
/ /
/ /
/ /
/ /
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DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES
(1) Name Miami Beach Advisory Council (2)I.D. Number
(3)Cover Period 05 / 01 / 15 through 05 / 31 / 15 (4) Page 1 of
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(6) (Last,Suffix,First,Middle) (add office sought if
Sequence Street Address& contribution to a Expenditure
Number City,State,Zip Code candidate) Type Amendment Amount
Triumph Fundraising Fundraising
05/01 / 15 1619 Lenox Ave #8
Miami Beach, FL 33139 MON $3,000.00
1
05/ 18 15 Messer Caparello, P.A. Legal/Administrativ
/
2618 Centennial Place e Fees
Tallahassee, FL 32308 MON $120.00
2
/
/ 1
/ /
DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES