DS-DE 12 Beach Residents for Quality of Life M11 CAMPAIGN TREASURER'S REPORT SUMMA►F,ZY;,, _
(1) Beach Residents for Quality of Life O :17you
4,10 uta,Name pH L5, 30
(2) 2618 Centennial Place
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)
SI 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 lE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 11 / 07 / 15 To 11 / 30 / 15 Report Type: M 1 1
0 Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ , 10, 800 . 00 Expenditures $ , , 0 . 00
Loans $ , , • Transfers to
Office Account $ •
Total Monetary $ , 10, 800.00
Total Monetary $ , 0 . 00
In-Kind $ •
(8) Other Distributions
$ ,
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ 10 , 800 . 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 nam-) Mark Herron (Type name)
❑ Individu.I(only for I- 0 Treasurer ❑ Deputy Treasurer ❑Candidate ❑Chairperson(only for PC and PTY)
or electio -ering c'• m
X
Signature Signature
DS-DE 12(Rev. 11/1 ) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS
Beach Residents for Quality of Life
(1) Name (2) I.D. Number
11 07 15 11 30 15 1 1
(3) Cover Period / / through I / (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
Dyal Corp.
11 06 2015 1228 Alzon Rd.
/ / 0 Miami Beach, FL 33139
B Real Estate Check $600.00
1
Mark G. Samuelian
11 / 12 /2015 200 E. 65th St., Apt
19FG
New York, NY 10065 I Real Estate Check $10,000.00
2
Jong-Suh, LLC
11 12 2015 1442 Alton Rd.
/ /
Miami Beach, FL 33139
B Printing Check $200.00
3
/ /
/ /
1
/ /
/ /
•
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 11 07 / 15 through 11 / 30 / 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
•
/
/
I
I
DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES