DS-DE 12 Jorczak 2015 M05 CAMPAIGN TREASURER'S REPORT SUMMARY, E . -�;
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(1) : h LJ rrC 2 a% OF ICE Ys$9r2 6
2 Name / r A& 4/5/2 _ s
Address(number and street)
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City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
AM-andidate Office Sought: C/ ogt am; £4 %' � is
jer)/ Gra? IT(. rro?
❑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 5 / 0/ / /5 To 05 I 3 / / /5 Report Type: )015 - ni t)
[I Original ❑Amendment ❑Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary 0
Cash &Checks $ , , 110. 00 Expenditures $ ,
Loans $ , 100 • _d Transfers to
Office Account $ ,
Total Monetary $ , 2 i0 . 00
Total Monetary $ , 0 . a
In-Kind $ ,
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ , , Z cv . oo $ , , D . (M
(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) lolref i JO-CZ-44 (Type name) (101 I 2 '-cztu
❑Individual(only for IE 'freasurer ❑Deputy Treasurer 'ndidate ❑Chairperson(only for PC and PTY)
or electioneering comm.)
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Si/atu / Si•atur/ . ■
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DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
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CAMPAIGN TREASURER'S REPORT-.ITEMIZED CONTRIBUTIONS
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(1) Name (2) I.D. Number
(3) Cover Period 7 / 0/ / /5 through (,)5 1 5/ / l-s (4) Page -I of 2
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last,Suffix, First, Middle)
Sequence Street Address& Contributor Contribution In-kind
Number TCity,State,Zip Code .Type 'Occupation Type Description Amendment Amount
e /5 1 1 H 3T iar 9scf 20.00
ia ; 134, FL
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J3/32
c 1 1 s L./ c7 czak
1 8 LA" (Vir I Yhti eg. *Oa
2 Lee Rh 0(233
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m, „ , 3316
5 20 /5- Tali 4 LTorcZR 1.-
1 / /`32 mP^4;?'41;4e� T Cji 2 LOI
lipo,N
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33139
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1 1
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DS-DE 13(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
iPitif . 14 )
CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES
(1) Name fee L.7 - (2)I.D.Number
(3)Cover Period ®c/ 0/, / through an 517 / S (4)Page 2 of 2
(5) (7) (8) (9) (10) (1 1)
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
/
ei
1 /
DS-DE 14(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
PA 11 31 3