DS-DE 12 Beach Residents for Quality of Life 2015-R2 CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Beach Residents for Quality of Life OFFICE USE ONLY
Name
(2) 2618 Centennial Place
Address (number and street)
Tallahassee, FL 32308
City, State, Zip Code PIA Jae, 01/4/Zo\ 5
❑ 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 / 31 / 15 To 11 / 12 / 15 Report Type: R2
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 na ) Mark Herron (Type name)
❑ Individu I(only for IE GI Treasurer ❑ Deputy Treasurer ❑Candidate ❑Chairperson(only for PC and PTY)
or election ering comm.)
X X
Signatu a Signature
DS-DE 12(R v. 11/13 SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS
Beach Residents for Quality of Life
(1) Name (2) I.D. Number
10 31 15 11 12 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
Dyal Corp.
11 06 2015 1228 Alzon Rd.
/ / ® 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
/ /
/ /
/ /
/ /
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 / 31 / 15 through 11 / 12 / 15 (4) Page 1 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
I I
/
1
/
I I
DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
WAIVER OF REPORT
(Section 106.07(7), F.S.)
(PLEASE PLEASE TYPE � VlC O bc
OFFICE rUSE ONLY
Beach Residents for Quality of Life
Name Office Sought
P.O. Box 1701 - Tallahassee FL 32302
Address City State Zip Code
ElCandidate El Political Committee Electioneering Communications Organization
IIParty Executive Committee
❑ Check here if address has changed since last report. ❑ Check here if PC or ECO has DISBANDED and will no
longer file reports.
TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box)
MONTHLY REPORT ri PRIMARY ELECTION GENERAL ELECTION DOTHER REPORT TYPE
Indicate report# Indicate report# Indicate report# Indicate report type and#
M 11 P G as applicable:
❑ TERMINATION REPORT ❑ SPECIAL ELECTION
NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF
Nov_ ier 13, 2015 THROUGH November 30, 2015
X 4.A.1.) ,OLFA Le 014 X02/ .. 2e/3
Signature Date
X
Signature Date
REQUIRED SIGNATURES FOR: Candidates:
Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.)
Political Committees:
Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.)
Electioneering Communications Organizations:
Treasurer (s. 106.0703(4)(c), F.S.)
Party Executive Committees:
Treasurer and Chairman (s. 106.29(2), F.S.)
In any reporting period when there has been no activity in the account(no funds expended or received)the filing of the required
report is waived. However,the filing officer must be notified in writing on the prescribed reporting date that no report is being filed.
DS-DE 87(Rev. 11/13)