DS-DE 12 Beach Residents for Quality of Life R1 CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Beach Residents for Quality of Life OFFICE USE ONLY
Name /. /
(2) 2618 Centennial Place Pit,' 1\ 1 S
Address (number and street)
Tallahassee, FL 32308 •
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
❑ Candidate Office Sought:
❑ Political Committee(PC)
0 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 10 / 30 / 15 To 10 / 30 / 15 Report Type: R1
Original ❑Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ , , 0 . 00 Expenditures $ , 4, 250. . 00
Loans $ • Transfers to
Office Account $
Total Monetary $ 0.00
Total Monetary $ , 4 250 ..00
In-Kind $
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ , 0 00 $ , 4 , 250 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 I have examined this report and it is true, correct, and complete:
(Type n.me) Mari Herron (Type name)
❑ Indivkual(only fo Fi Treasurer ❑Deputy Treasurer ❑Candidate ❑Chairperson(only for PC and PTY)
or electi neering co
X
Signat re Signature
DS-DE 12(' -v.11/ 3) SEE REVERSE FOR INSTRUCTIONS
_ .. —CAMPAIGN TREASURER'S REPORT ITEMIZED CONTRIBUTIONS
Beach Residents for Quality of Life
(1) Name (2) I.D. Number
10 30 15 10 30 15 " 1 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
/ /
/ /
/ /
•
/ /
/ /
/ /
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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 10 / 30 / 15 through 10 / 30 / 15 (4) Page of 1
(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
National Campaign Resource Group, Mailing
10/30 /15 LLC
11380 Prosperity Farms Rd. Ste 221E • MON $4,250.00
Palm Beach Gardens, FL 33410
1
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/, /
/ /
/
DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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