DS-DE 12 Jorczak 2015-M8-1 CAMPAIGN TREASURER'S REPORT SUMMARY
a�(1) je---)yA �"YL Z OFFICE USE ONLY
Name _ �, I- ;, � i i' ' ' := 'i",.
(2) f ?Z J7 / / IIZ 2015 SEP
. I 1 P 3:
03
Address (number and street)
y X64,01, � 32/39 CITY CL_Lt OFFICE
/
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
Candidate Office Sought: �'1^
/ /'��
3.,_s Political Committee (PC)
l
❑ Electioneering Communications Org. (ECO) El Check here if PC or ECO has disbanded
[I 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 0,8 / Of / ts- To , / 7 / / ,3 Report Type: Mi
XOriginal ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ , , -6'. t® Expenditures $ , , 6 . 00
Loans $ 10 • 00 Transfers to
Office Account $ • , , 0 . 00
Total Monetary $ , , S, • Ob
Total Monetary $ .3-b . 06
,
In-Kind $ , , • 0
(8) Other Distributions
$ , , d . 00
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ , , -‘‘ . 00 $ , , 1 -.56 . O0
(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) o,f' ' h jo-r6 Z��" (Type name) Q! A ( SYG zu L
❑ Individual(only for IE kr reasurer ❑ Deputy Treasurer
❑ Chairperson(only for PC and PTY)
or electioneering comm.) !
X 1 x I,,., 4 j,,,,../1,
Signature _ Signature
DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMP AIG ASURER'S REPORT — ITEMI ONTRIBUTIONS---)114—(1) Name ~--v (2) I.D. Number
(3) Cover Period 6 / 0 ( / 1> through a / -7( / / 4) Page --1-- of
( 9
(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
61 15" I, TAA1 1 1
i___ -#-(f
32 T c 40- 120
fl'i2', FL g777
( �l iirix- tiht,616 5 44.3_,
2__ Ftet*
1171141t/fe45 _____
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i 5-37 1//4161# At ', 13 $61,51-0"6114 A-5 11- ))16, IL 33/39 . -,-
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DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Ay 24 I
______ I
AM L11(_ 1 TR _ASURER'S REPORT- ITEMIZED EXPENDITURES
(1) Name (2) I.D. Number
I
(3) Cover Period g l 01 / 15 through a ,/ ` ,1 l ( c (4) Page 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
og/137 Latd
32 co— IV W 3' S 11(16wtadk
f 33/((
1
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DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
411 3