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DS-DE 12 Jorczak TR CAMPAIGN TREASURER'S REPORT SUMMARY s�. (1) \j(-)S� k Jarc-cas OFFICE_U,SE ONLY Name 2M FEB - PA 114 . 1 Address (number and street) ,7 r/k i Ittac.k. (1 - -137 City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): �� 12/Candidate Office Sought: C 71 67 Orir'17-5.510/1 rou p V ❑ 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 3 / 19 I IS" To i1 I O / JS Report Type: 1 5-Original ❑Amendment ❑Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash &Checks $ , _„.. 11.1,4r:fKer Expenditures $ , , _ II 0 Loans $ , , • Transfers to Office Account $ , , • Total Monetary $ , ,'Y .:41,--cl Total Monetary $ i 40 0 In-Kind $ , , • (8) Other Distributions $ , -- - (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ , , __ . G $ , 5-4 6 . ue1_ (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 a , it is true,correct,and complete: / T e name) �,,1! / ' (Type name) ° /I ( YP ) / / (TYp ) i e , ----- ❑Individual(only fo [( Treasure- ❑Deputy Treasurer [Candidate / ❑Chairpe "on(o ly for PC and PTY) or electioneering comm.) X X �, / � ' ) . Signature / Signatu /1 DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS ----- L.c..::y__ 1 0 CZ___ f CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES (1)Name �J e2S �- i 1 o s 1-z-L( (2) I.D. Number (3)Cover Period 09 / I l 6 through I? /JO / 1 S (4)Page / of J (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 11 l(j 1 0 FOI 4.e Gc\ f o vh )) th&uc\ 36'i- 14a6 Ore.xd �b4\ y 5oO e2./-vt-fro If\ _5 IM‘.r, 5e;�h, -(1 333311 6ti4k 4)/Nw“C � 1/ 1/ 11S /9 i1J /II ion 'a fn U r\ 5_‘,60 .„2 r.„„r,, ,-,,,i... F� 33131 glen V -lee 1 l l 1 1 / 1 l / 1 1 1 DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES l 't, y__. Z C'c 7