DS-DE 12 Beach Residents for Quality of Life 2016-M12 CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Beach Residents for Quality of Life OFFICE USE ONLY
Name • 2017 _Ipit h 10: 08
(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)
12 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 12 / 01 / 16 To 12 / 31 / 16 Report Type: M12
12 Original ❑Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ , 0 . 00 Expenditures $ , , 3 . 00
Loans $ • Transfers to
Office Account $
Total Monetary $ 0.00
Total Monetary $ , 3 . 00
In-Kind $
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ , 4 , 300 • 00 $ 4 , 253 , 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 nave) Mar ' erron (Type name)
❑ Individ al(only for I: GI Treasurer ❑Deputy Treasurer El Candidate ❑Chairperson(only for PC and PTY)
or electio eering corn
x ✓�, x
Signature Signature
DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS
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CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Beach Residents for Quality of Life
(1) Name (2) I.D. Number
12 01 16 12 31 16 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
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13(Rev.11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES
(1) Name Beach Residents for Quality of Life (2) I.D. Number
(3)Cover Period 12 / 01 / 16 through 12 / 31 / 16 (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
Hancock Bank Dormant Account Fee
12/27 / 16 P.O. Box 4019
Gulfport, MS 39502-4019
MON $3.00
1
/ /
/ /
/ /
/ /
/ /
DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES