DS-DE 12 Jorczak 2015-M8 CAMPAIGN TREASURER'S REPORT SUMMARY
(1) J-0---)y/ OFFICE USE ONLY
Name � '' ` -
(2) 1‘32- / r71/_ 4/1112 2015 SEP 1 1 PM
Address (number and street)
pl r' /L 32/29 CITY OFFICE
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
G 1 ,
Candidate Office Sought: Yin.
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 0 X / Of / ts- To a / 3 / / ,S Report Type: Mi
X0riginal ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ , , _6'. 2e2 Expenditures $ , , 6 00
Loans $ _ , , ea - 00 Transfers to
Office Account $ , , 0 . 00
Total Monetary $ , , S • 0,0
Total Monetary $ 3-b . 06
In-Kind $ , , 0 • 0d
(8) Other Distributions
$ , , . 0a
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ , YY‘ . 00 $ , , �6 . 60
(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 f
(Type name) jOi / h jar6 24'1" (Type name) Q1 A ' Y-0 zu L
❑ Individual(only for IE !/.""1 reasurer ❑ Deputy Treasurer
andidate 0 Chairperson(only for PC and PTY)
or electioneering comm.) ! ,
x ` x „1
Signature Signature
DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
O o :.:7
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name /� 1 rMZ (2) I.D. Number
(3) Cover Period 6 / 0 ( / is- through a 13 (4) Page of Z
(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
oi rc 15 4PotAl 2
3 1 fy,4719 C ,�- 120
Ylif, FL 83177
f J /5- [NA tt4"16 T r
C,&c
Sit*
Og lc irc
I pre,
i[ovw(off
410
IC IC 1.6'1114
1 G $14(1-04A,614
1 37 �4.1 G CAS 1-f 121
0,6 , IL �3(39
•
Cri
, E .
/ /
C:7
C—)
W
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
24 3
r
IVIPAIG I TREASURER'S REPORT- ITEMIZED EXPENDITURES
(1) Name (% o `// ZD '- (2) I.D. Number
(3) Cover Period di / 01 / / through a , 7/ , (c (4) Page 2 of 2
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(S) (Last, Suffix, First, Middle) (add office sought if
Sequence
Street Address& contribution to a Expenditure
Number City, State,Zip Code candidate) Type Amendment Amount
6g/137 l;
S
3245 0/ 3 fi itwityll^^mvk
�- I f 23/aa S
/ /
/
.�--
_ E I
t C:2
/ /
DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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