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HomeMy WebLinkAboutQualifying Packet JB - 08-12-2016 D'"-'- 1 co t �_L) o0 g ••¢a l " JUa=UG 0 O ❑❑❑❑❑ 7 --:8' j Ea 5 s o I CO . N _ �} 1J ba Ea Ea 5mm rD U E.C� X r mgr csg> , c = I- Jz EW . „� 0 . , ccs.gc0 Q ❑ j 0 a 0 0 F- I- w W z z c.) o o z 2 � L L Q 1 m 4-74)1H1 CLL1‘; CITY OF CAPE CANAVERAL, FLORIDA QUALIFYING PACKET FOR PERSONS WHO ANNOUNCED CANDIDACY PRIOR TO QUALIFYING PERIOD I, 9,,V /�p , previously announced my candidacy for City Council and do hereby acknowledge receipt of additional materials as follows: • Form DS-DE 25 (rev. 05/11), Candidate Oath — Non-Partisan Office and Affidavit of Nickname • City Oath of Candidate • CE Form 1, (Jan 1, 2016) Statement of Financial Interests and Instructions • Election Laws of the State of Florida as of ..7:4 2a/G • Candidate and Campaign Treasurer Handbook as of Janury-2015 Zo944 • Form DS-DE 87 (rev. 6/15), Waiver of Report • 2016 General Election Canvassing Board Dates I understand to have my name appear on the November 8, 2016 Municipal Election Ballot, I must complete qualifying paperwork and pay qualifying fees during the qualifying period which begins on August 12, 2016 at noon and ends August 26, 2016 at noon. 0/zZ7/4 Signature Date C; E. I �' -- AUG 12 2016 Enter Date&Time Received and Initials of Clerk's Office Staff Member � C C C ODIC CANDIDATE OATH - NONPARTISAN OFFICE AUG 1 2 2016 (Not for use by Judicial or /2-�J /frL School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021, Florida Statutes) I, ..,.1p,9/%P ,K,AI (PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT*-- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of G0�//v 7, im477,/w/Z (office) (district#) ; I am a qualified elector of /�,�ir///0lL3 County, Florida; (circuit#) (group or seat#) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. X _ (SZA Zy8—///g /1/Nri "tifj04//1'yo/✓D • ^J47' Signature of Candidate Telephone Number Email Address $9�/ p/ . % z- 6/4,7i� G/1/r4,/j L Pi 3Z-9z0 Address City State ZIP Code Candidate's Florida Voter Registration Number(located on your voter information card): * Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons with disabilities (see instructions on page 2 of this form): STATE OF FLORID COUNTY OF /9rrar¢/zi-3 Sworn to (or affirmed) and subscribed before me this 3 day of ,0(11'5/ , 20 /6 . L.// 'o`�i MIA GOFORTH Personally Known: or ; �`9' fL Notary Public -State of Florida ` 4 My Comm.Expire:;May 16,2017 Signature of Notary Public sir OPrint,Type, StampNotary Produced Identification: ,,E-%":-4W Commission # EE 866939 or Commissioned Name of Public '°'° ' Bonded Through National Notary Assn Type of Identification Produced: DS-DE 25(Rev.5/11) Rule 1S-2.0001,F.A.C. INSTRUCTIONS: INSERTING PHONETIC SPELLING OF CANDIDATE'S NAME FOR AUDIO BALLOT Use the PRONUNCIATION KEY below to provide pronunciations for ambiguous first names and surnames. Capitalize STRESSED syllables, use lower case for unstressed syllables. Use dashes (-) to separate syllables. You should also add any notes such as rhyming examples, silent letters, etc. Samples: PRONUNCIATION KEY Stressed Vowel Sounds NAME ON BALLOT PRONOUNCED AS EE (FEET)feet (FIT)fit Mishaud mee-SHO('d'is silent) E (BED)bed A (KAT)cat(KAD)cad Jahn HAHN(rhyme:fawn) AH (FAH-thur)father Beauprez boo-PRAI(rhyme:hooray) (PAHR)par AH (HAHT)hot(TAH- Maniscalco man-uh-SKAL-ko dee)toddy UH (FUHJ)fudge Tangipahoa TAN-ji-pah-HO-uh (FLUHD)flood Monte Mahn-TAI UH (CHUHRCH)church AW (FAWN)fawn Tanya TAWN-yuh(not TAN) U (FUL)full 00 (FOOD)food OU (FOUND)found O (FO)foe El (FEIT)fight Al (FAIT)fate 01 (FOIL)foil YOO (FYOOR-ee-uhs) furious Unstressed Vowel Sounds uh (SO-fuh)sofa(FING- guhr)finger Certain Vowel Sounds with R AHR (PAHR)par ER (PER)pair IR (PIR)peer OR (POR)pour OOR (POOR)poor UHR (PUHR)purr Consonant Sounds B (BED)bed TS (ITS)its(PITS-feeld)Pittsfield D (DET)debt TH (THEI) Thigh F (FED)fed TH (THEI) Thy G (GET)get ZH (A-zhuhr)azure(VI-zhuhn)vision H (HED)head Z (GOODZ)goods(HUH-buhz-tuhn)Hubbardston HW (HWICH) which J (JUNG)jug K (KAD)cad L (LAIM)/ame M (MAT)mat N (NET)net NG (SING-uhr)singer P (PET)pet R (RED)red S (SET)set T (TEN)ten ✓ (VET) vet Y (YET)yet W (WICH) witch CH (CHUCRCH)church SH (SHEEP)sheep NOTE: This page should not be submitted to the filing officer. Page 2,DS-DE 25(Rev.5/11) Rule 1S-2.0001,F.A.C. 4pCE Aly_ s f4:? nil ■ n445251°F-- - OATH OF CANDIDATE I, --J0///V 3'A'9 , do solemnly swear or affirm that I am qualified under the City of Cape Canaveral Charter and Ordinances to hold the Office of Council Member, to which I desire to be elected and I will support the City of Cape Canaveral Charter and Ordinances. Signature of Candidate State of Florida County of Brevard City of Cape Canaveral Sworn to (or affirmed) and subscribed before me this day of August, 2016 by � -wit( , who is personally known or produced a- Identification. s,T u . MIA GOFORTH Notary Public-State of Florida / , , 3•: •,`: •5 My Comm.Expires May 16,2017 \ /Q :,-,,�s ; Commission # EE 866939 ...... Bonded Through National Notary Assn. Signature o otary Public Print,type or stamp Commissioned Name of Notary Public FORM 1 STATEMENT OF 2015 Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY: address,agency name,and position below: LAST NAME--FIRST NAME--MIDDLE NAME moo/ D, P MAILINGDDRESS : 993/ 419/4s-i>/E. yo z CITY: ZIP: COUNTY: E C E `-r E 3Zzv /.ek'A ) NAME OF AGENCY: AUG 1 2 2016 C, / off' G�7/5' cifivA 4 Z/1 L NAME OF OFFICE OR POSITION HELD OR SOUGHT: G®!/�1✓G/L !_ / /2;55-S You are not limited to the space on the lines on this form.Attach additional sheets,if necessary. CHECK ONLY IF [ CANDIDATE OR J NEW EMPLOYEE OR APPOINTEE **** BOTH PARTS OF THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER(must check one): ❑/ DECEMBER 31, 2015 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES,WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING(must check one): ❑ COMPARATIVE (PERCENTAGE)THRESHOLDS OR ❑ DOLLAR VALUE THRESHOLDS PART A--PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF SOURCE SOURCE'S DESCRIPTION,OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY GIJX0Z?' /SriAr r AG4',A 700/N•/9 G.f4Afilb/ 41Ft14/4t/if PAPP ,J J7f /)(Sf4"s c'ly of 4/2VS.449/01M7A- /40.5-R49G/440Z,Gieir adOW'`Rb L bW/✓4/G /1iisjm ri PART B- SECONDARY SOURCES OF INCOME [Major customers,clients,and other sources of income to businesses owned by the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE PART C--REAL PROPERTY [Land, buildings owned by the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") FILING INSTRUCTIONS for when and where to file this form are ,� located at the bottom of page 2. / �•'I hn /'"a/a/0 , INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM 1-Effective:January 1,2016 (Continued on reverse side) PAGE 1 Incorporated by reference in Rule 34-8.202(1).F.A.C. PART D—INTANGIBLE PERSONAL PROPERTY[Stocks, bonds,certificates of deposit,etc. -See instructions] (If you have nothing to report,write"none"or"n/a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES Pii0a5�,/7d, �l %x`10104) 77$P-54N4L PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF CREDITOR ADDRESS OF CREDITOR PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions] (If you have nothing to report,write"none"or"n/a") BUSINESS ENTITY#1 BUSINESS ENTITY#2 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5%INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST PART G—TRAINING For elected munici officers required to complete annual ethics training pursuant to section 112.3142, F.S. I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney Signature: in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement I, , prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes. and the instructions to the form.Upon my reasonable knowledge and belief,the disclosure herein is true and correct. Date Signed: , • • ,60Z�Q/( : � w CPA/Attorney Signature: Date Signed: FILING INSTRUCTIONS: WHAT TO FILE: WHERE TO FILE: WHEN TO FILE: After completing all parts of this form, including If you were mailed the form by the Commission Initially,each local officer/employee,state officer, signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within sheet(pages 1 and 2)for fling. your annual disclosure filing, return the form to 30 days of the date of his or her appointment that location. or of the beginning of employment. Appointees If you have nothing to report in a particular Local officers/employees file with the who must be confirmed by the Senate must file section, you must write "none" or "n/a" in that Supervisor of Elections of the county in which they Prior to confirmation, even if that is less than section(s). permanently reside. (If you do not permanently 30 days from the date of their appointment. reside in Florida, file with the Supervisor of the Candidates must file at the same time they file NOTE: county where your agency has its headquarters.) their qualifying papers. MULTIPLE FILING UNNECESSARY: State officers or specified state employees Thereafter,file by July 1 following each calendar A candidate who previously filed Form 1 because year in which they hold their positions. file with the Commission on Ethics, P.O. Drawer of another public position must file a copy of 15709, Tallahassee, FL 32317-5709; physical Finally, file a final disclosure form (Form 1F) his or her Form 1 when qualifying. A candidate address: 325 John Knox Road, Building E, Suite within 60 days of leaving office or employment. who files a Form 1 with a qualifying officer is 200,Tallahassee, FL 32303. Filing a CE Form 1F(Final Statement of Financial not required to file with the Commission or • Interests)does 1Q relieve the filer'of filing.a CE Supervisor of Elections. Candidates file this form together with their Form 1 if the filer was in his or her position on qualifying papers. December 31,2015. Facsimiles will not be accepted. To determine what category your position falls under,see page 3 of instructions. CE FORM 1-Effective.January 1,2016. PAGE 2 Incorporated by reference in Rule 34-8.202(1),F.A.C. CAMPAIGN TREASURER'S REPORT SUMMARY (1) 1/0/4/ /540 L ' �E Y� Name ❑ (2) 97/ � Address (number and street) AUG 1 9 2016 1 /l//1///r4//G -9-13 X.� City, State, Zip Code (_ 'C � ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): Candidate Office Sought: Gil//'✓G/L- /1/1f/P /z-j2 ❑ 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 Og / / Z/b To / /Z- / Zil Report Type: /Q Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , , • Expenditures $ , 3 • 4r; Loans $ , /Ob • 00 Transfers to Office Account $ • Total Monetary $ , , • Total Monetary $ , ,07f • Oa In-Kind $ , , • (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ t'9; • (i $ , , a39 • o� (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 haveexamined this report and it is true, correct, and complete: (Type name) Jr O//g/ a/to (Type name) .J4 /VO/✓4 ❑ Individual(only for IE Treasurer 0 Deputy Treasurer fl Candidate El Chairperson(only for PC and PTY) or electioneering comm.) X 57 Signature Signature DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS `-- (31161 1J(e (1) Name J®/// /37/,/, (2) I.D. Number (3) Cover Period /29/ 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 g93/z 4 2 Z S '4140/0 C 927 / / / / / / / / / / / / DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES iiiii 1111114 CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name -Jb/1/v,0{4 (2) I.D. Number (3)Cover Period O, /4 /2.0/4 through 05 / / / zd�-6 (4) Page of (5) (7) (8) (9) (1 0) (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 9770//6 GiTy o/6-GG/ai,v47z i G ////GYM /0... ,'W/640 /= /lay/ 39 0 .4,7,, /y9��/?, , L 9Z / / / / / / / / / / / / / / DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES WAIVER OF REPORT I AUG 2 5 2016 (Section 106.07(7), F.S.) t (PLEASE TYPE) r .i'! /0.2 may 9i . it#/V 5O// 'o✓�G/ %yl€�i3i Name Office Sought g93/ /1/ �,U *2-- '/,97/ G1/1//6)1/1// r/IG AG -? 9z6 Address City State Zip Code EICandidate ❑ Political Committee ❑ Party Executive Committee NOTE: This form does not apply to an electioneering communications organization(ECO). An ECO must file a report(not a waiver)that no reportable contributions or expenditures were made during the reporting period(s. 106.0703(6), F.S.). n Check here if address has changed since last report. n Check here if PC has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) ❑ MONTHLY REPORT PRIMARY ELECTION ❑ GENERAL ELECTION ❑ OTHER REPORT TYPE Indicate report# Indicate report# Indicate report# Indicate report type and# M P G as applicable: TERMINATION REPORT SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF g/.. 0,/_ / THROUGH �/2s/ZD/7 X ---- , 9"'4 /I 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.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) Except as noted above for an ECO, 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.06/15) WAIVER OF REPORT (Section 106.07(7), F.S.) (PLEASE TYPE) Name Office Sought Address City State Zip Code ❑ Candidate ❑ Political Committee ❑ Party Executive Committee NOTE: This form does not apply to an electioneering communications organization (ECO). An ECO must file a report (not a waiver) that no reportable contributions or expenditures were made during the reporting period (s. 106.0703(6), F.S.). ❑ Check here if address has changed since last report. ❑ Check here if PC has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) ❑ MONTHLY REPORT ❑ PRIMARY ELECTION ❑ GENERAL ELECTION ❑ OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M P G as applicable: ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF X &/Z2�/26/-61 THROUGH Signature Signature -77 Date 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.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) Except as noted above for an ECO, 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. 06/15) CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name ---/ '1-71/11 &'A/ (2) I.D. Number (3) Cover Period 9 / 3 I 2-D4 through 9 / /6 / 2,4 (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 , J,6-AfL,/,/12t /L y j1E72ei-/) ci/f /go. op Go o..P CG 709'z2 PST.EX c��/ -1,(1/1/9 / 7 1 /r/ '75/4044._ 7 54.E _ ggelGVZ 111",e G/9///0 L?4z$9 t C/0257 as Z ms , I / / / / I / I DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES Rf © llVL ;1 SEP 232016 r e, J CAMPAIGN TREASURER'S REPORT - ITEMIZED DISTRIBUTIONS (1) Name J 9/7 /S2/1/) (2) I.D. Number (3) Cover Period CJ / / 2.3/6 through 9 / 4 / zg/-U (4) Page of (5) (7) (8) (9) (10) (11) (12) Date Full Name Purpose (6) (Last,Suffix, First,Middle) (add office sought if Sequence Street Address& contribution to a Related Distribution Number City,State,Zip Code candidate) Expenditures Amendment Amount Type / l / / / / / / / / / / / / / / DS-DE 14A(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES D SEP 2 3 2016 Gco CAMPAIGN TREASURER'S REPORT - ITEMIZED DISTRIBUTIONS THIS FORM IS USED TO REPORT DISTRIBUTIONS OF GOODS OR SERVICES CONTRIBUTED TO A CANDIDATE OR COMMITTEE, INDIRECT EXPENDITURES AND REIMBURSEMENTS. (1) Name of the entity. (2) Identification number assigned by the filing officer. (3) Cover period dates (e.g., 03/01/14 through 03/31/14). (See the filing officer's reporting dates calendar for appropriate cover periods.) (4) Page numbers (e.g., 1 of 3). (5) Date of distribution (Month/Day/Year). (6) Sequence Number- Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer. This method of unique identification is required for responding to requests from the filing officer and for reporting amendments. For example, a M1 report having 40 distributions would use sequence numbers 1 through 40. The next report (M2), comprised of 30 distributions would use sequence numbers 1 through 30. Distributions on amended M1 reports would begin with sequence number 41 and on amended M2 reports would begin with sequence number 31. See Amendment Type instructions below. (7) Full name and address of entity receiving distribution (including city, state and zip code). (8) Purpose of distribution (if distribution is a contribution to a candidate, also type the office sought by the candidate). (9) For each distribution that is related to an itemized expenditure previously listed on Itemized Expenditures (Form DS-DE 14), enter the Year, Report Type and Sequence Number associated with the expenditure. *PARTY EXECUTIVE COMMITTEES ONLY - If distribution is allocable toward the contribution limits, type an "A" in this box. If distribution is nonallocable,type and "N". (10) Amendment Type (required on amended reports) - To add a new (previously unreported) distribution for the reporting period being amended, enter"ADD" in amendment type on a line with ALL of the required data. The sequence number for distributions with amendment type "ADD" will start at one plus the number of distributions in the original report. For example, amending and original M1 report that had 75 distributions, means the sequence number of the first distribution having amendment type "ADD" will be 76; the second "ADD" distribution would be 77, etc. When amending an original M2 report that had 30 distributions, the ninth "ADD" distribution would have sequence number 39. To correct a previously submitted distribution use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the distribution to be corrected. In combination with the report number being amended, this sequence number will identify the distribution to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assigns the sequence number as described above. (11) Amount of distribution. (12) Distribution Type Code Description PPD Pre-paid Distribution RMB Reimbursements CCP Credit Card Purchase INK In-Kind Distribution CAMPAIGN TREASURER'S REPORT SUMMARY (1) --10# // L� SL! TIE Name D (2) g5P / /a SEP 2 6 2016 I Address (number and street) C"i�/ZC'9G✓�'4 v L,/2' , ��'� City, State, Zip Code e6 U Check here if address has changed (3) ID Number: (4) Check appropriate box(es): Candidate Office Sought: vdlvGfli�Jl/�/�/L ❑ 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 / .3, 4 To 9 l /G / 3,4 Report Type: Z 0 Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , , . a b Expenditures $ , O . U p Loans $ , , • Transfers to Office Account $ • Total Monetary $ • Total Monetary $ In-Kind $ • (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ , V5c ov (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 name) _jai ✓/ 7,91e (Type name) Jdy/,O,/ff2) ❑ Individual(only for IE ❑Treasurer ❑ Deputy Treasurer ❑Candidate ❑ Chairperson(only for PC and PTY) or electioneering comm.) Signatur- Signature DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS Instructions for Campaign Treasurer's Report Summary (1) Name: full name of the candidate, political committee, party executive committee, electioneering communications organization, or individual making an independent expenditure or electioneering communication. (2) Address: the full address or post office box, city, state, and zip code. Check the box if the address has changed since the last report filed. (3) ID Number: identification number assigned by the filing officer. (4) Check the appropriate box(es). (5) Report Identifiers Cover Period: the dates this report covers (i.e., From 1/1/15 To 1/31/55). Important: use the appropriate cover period dates as published by the filing officer. Report Type: refer to the filing officer's calendar of reporting dates for the correct codes to be used for each reporting period. If report is for a special election add "S" in front of the report code (i.e., SG3). Check one of the appropriate boxes: Original: first report filed for this reporting period. Amendment: must summarize only contributions/fund transfers and expenditures/distributions being reported as additions or deletions. Read instructions for sequence numbers and amendment types on the back of Forms DS-DE 13A and 14A. Special Election Report: Important: once a special election report is filed, the entity is required to file all remaining reports due for the special election. (6) Contributions This Report: Cash and Checks: total amount for this reporting period. Loans: total amount for this reporting period. Total Monetary: sum of Cash and Checks and Loans. In-Kind: the fair market value of the in-kind contribution at the time it is given for this reporting period. (7) Expenditures This Report: Monetary Expenditures: total amount of monetary expenditures for this reporting period. Transfers to Office Account: total amount transferred to an office account by elected candidates only. Total Monetary: sum of Monetary Expenditures and Transfers to Office Account. (8) Other Distributions: the total amount of goods and services contributed to a candidate or other committee by a PC, ECO, or PTY. (9) TOTAL Monetary Contributions To Date: the amount of total monetary contributions to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (10) TOTAL Monetary Expenditures To Date: the amount of total monetary expenditures to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (11) Type or print the required officer's name and have them sign the report: Candidate report: treasurer and candidate must sign. ❑ PC report: treasurer and chairperson must sign. ❑ PTY report: treasurer and chairperson must sign. C ECO report: organization's treasurer must sign. ❑ IE or EC report: individual must sign (this applies when an individual acts alone to make these expenditures) AMENDMENT REPORTS: An amendment report summary should summarize only contributions, expenditures, distributions, & fund transfers being reported as additions or deletions. Read the instructions for the sequence number & amendment type fields on the back of forms DS-DE 13, 14, 14A and 94. ; 1 • - • 1 , , \ ' ' ' •,,. k • , i N4'. Lit-n iez, fig ..--• = --- El. ..... __. T., v .... __. _... ... ,... ,.. i....., N'' , — — .... .. !‹ . • ..... .• • ,-,3.. t --.: i.... 1,.' = k 1\\ t, 't ,i \ , s... NI , \N \I 1 , N ‘t, .3, .2 , , . . , ; ,I. , V 72 3 1! & 1 n .1'i(5 • CAMPAIGN TREASURER'S REPORT SUMMARY (1) Ja/-i' ffo%J 4,„N iC____ Name (2) i4/eo ,PR. a2- f Address (number and street) Ill. OCT 10 2016li City, State, Zip Code ° GC-JO ,_, Check here if address has changed (3) ID Number: (4) Check appropriate box(es): O Candidate Office Sought: COU/'/6/ /l//)17ij/Z ❑ 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 9 / /7 / /1 To 9 / Ip I /6 Report Type: Gj,57 D Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ i ' c,V Expenditures $ , -�S.,, . Loans $ , , • Transfers to Office Account $ , , . Total Monetary $ Total Monetary $ , . In-Kind $ , , • (8) Other Distributions $ , , • (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures}//� To Date $ , , /.So 4.0 $ , , //V . QU (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 name) .,....-b/71/1/ 04/2) (Type(Tname) J�/�� ��� � y ❑ Individual(only for IE Treasurer ❑ Deputy Treasurer 'Candidate ❑Chairperson(only for PC and PTY) or electioneering comm.) x /9.i — X Signature Signature DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS Instructions for Campaign Treasurer's Report Summary (1) Name: full name of the candidate, political committee, party executive committee, electioneering communications organization, or individual making an independent expenditure or electioneering communication. (2) Address: the full address or post office box, city, state, and zip code. Check the box if the address has changed since the last report filed. (3) ID Number: identification number assigned by the filing officer. (4) Check the appropriate box(es). (5) Report Identifiers Cover Period: the dates this report covers(i.e., From 1/1/15 To 1/31/55). Important: use the appropriate cover period dates as published by the filing officer. Report Type: refer to the filing officer's calendar of reporting dates for the correct codes to be used for each reporting period. If report is for a special election add "S" in front of the report code(i.e., SG3). Check one of the appropriate boxes: Original: first report filed for this reporting period. Amendment: must summarize only contributions/fund transfers and expenditures/distributions being reported as additions or deletions. Read instructions for sequence numbers and amendment types on the back of Forms DS-DE 13A and 14A. Special Election Report: Important: once a special election report is filed, the entity is required to file all remaining reports due for the special election. (6) Contributions This Report: Cash and Checks: total amount for this reporting period. Loans: total amount for this reporting period. Total Monetary: sum of Cash and Checks and Loans. In-Kind: the fair market value of the in-kind contribution at the time it is given for this reporting period. (7) Expenditures This Report: Monetary Expenditures: total amount of monetary expenditures for this reporting period. Transfers to Office Account: total amount transferred to an office account by elected candidates only. Total Monetary: sum of Monetary Expenditures and Transfers to Office Account. (8) Other Distributions: the total amount of goods and services contributed to a candidate or other committee by a PC, ECO, or PTY. (9) TOTAL Monetary Contributions To Date: the amount of total monetary contributions to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (10) TOTAL Monetary Expenditures To Date: the amount of total monetary expenditures to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (11) Type or print the required officer's name and have them sign the report: Candidate report: treasurer and candidate must sign. C PC report: treasurer and chairperson must sign. PTY report: treasurer and chairperson must sign. C ECO report: organization's treasurer must sign. IE or EC report: individual must sign (this applies when an individual acts alone to make these expenditures) AMENDMENT REPORTS: An amendment report summary should summarize only contributions, expenditures, distributions, &fund transfers being reported as additions or deletions. Read the instructions for the sequence number & amendment type fields on the back of forms DS-DE 13, 14, 14A and 94. CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name . 0*fi0/f/ (2) I.D. Number q i (3) Cover Period / / /7 / /6 through 9 I la (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 q // Tl�/�6 7 p c XaG/J/L� ,J / y0 /�!� /� 0GyGD/YA''/77/'k /ter G'/'// / Gda. a0 7Gz S Atidarl/d +llI 61244fAo,��� Bzz 9 Z� , /6 444A164G/F ,��rr# �1�'r� maisaawp zeN Z 071-GAMPil A1-/ / Cyr �z a 9 J4/ij j r--b�G/6 / / Z l /� 70// /9 slfae s X ",/ll J PR.. a/v/ Gly Sov D c/?1V)P // 9 , 27 /6 w, /AA X04/4 0-7/r 74? A2 /l f/- / C� jdo.6� c•9/ ,//�1F,4L/ 2 / / / / DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES F INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Candidate's full name or name of the political committee (PC), electioneering communications organizations (ECO)or party executive committee (PTY). (2) The identification number assigned by the filing officer. (3) Cover period dates (e.g., 1/1/15 through 1/31/15). (See filing officer's reporting dates calendar for appropriate year and cover periods.) (4) Page numbers (e.g., 1 of 3 ). (5) Date contribution was RECEIVED(Month/Day/Year). (6) Sequence Number—Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer. This method of unique identification is required for responding to requests from the filing officer and for reporting amendments. For example, a M1 report having 75 contributions would use sequence numbers 1 through 75. The next report(M2), comprised of 40 contributions would use sequence numbers 1 through 40. Contributions on amended M1 reports would begin with sequence number 76 and on amended M2 reports would begin with sequence number 41. See the Amendment Type instructions below. (7) Type full name and address of contributor(including city, state and zip code). (8) Enter the type of contributor using one of the following codes: Occupation of contributor for contributions over$100 only. (If a business, please indicate nature of business.) I Individual B Business (also includes corporations, organizations, groups, etc.) E Electioneering Communications Organizations F Political Committee (federal or state) P Political Parties (includes federal, state and county executive committees) O Other (e.g., candidate surplus funds to party, etc.) S Candidate to Self (9) Enter Contribution Type using one of the following codes: NOTE: Cash includes cash and cashier's checks. Code Description CAS Cash or Cashier's Check CHE Check COF Carryover Funds from Previous Campaign INK In-Kind INT Interest LOA Loan MO Money Order MUC Multiple Uniform Contributions RCT Other Receipts REF Refund (Negative Amount Only) CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES (1) Name J6// /o/v'/ (2) I.D. Number (3) Cover Period 9 / /7 / /6 through 9 /-3P / (4) Page 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 q111 /! 7d4rv.�✓��r�s �o��rl��✓ic,�j�o%'f �.�,��i�,�', /00 / l / l l DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES r • INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Candidate's full name or name of the political committee (PC), electioneering communications organization (ECO), or party executive committee(PTY). (2) Identification number assigned by the filing officer. (3) Cover period dates (01/01/15 through 01/31/15). (See filing officer's reporting dates calendar for appropriate cover periods.) (4) Page numbers (e.g., 1 of 3). (5) Date of expenditure (Month/Day/Year). (6) Sequence Number - Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer. This method of unique identification is required for responding to requests from the filing officer and for reporting requirements. For example, a M1 report having 40 expenditures would use sequence numbers 1 through 40. The next report (M2), comprised of 30 expenditures would use sequence numbers 1 through 30. Expenditures on amended M1 reports would begin with sequence number 41 and on amended M2 reports would begin with sequence number 31. See Amendment Type instructions below. (7) Full name and address of entity receiving payment(including city, state and zip code). (8) Purpose of expenditure (if expenditure is a contribution to a candidate, also type the office sought by the candidate). PLEASE NOTE: This column does not apply to candidate expenditures, as candidates cannot contribute to other candidates from campaign funds. However, PCs (supporting candidates) and party executive committees contributing to candidates must report office sought(Section 106.07, F.S.). (9) Enter Expenditure Type using one of the following codes: Code Description CAN Candidate Expense DIS Disposition of Funds DFC Disposition of Funds to Future Campaign (effective 11/1/13) DPP Disposition of Funds to Political Party(effective 11/1/13) DPV Disposition of Funds to Petition Verification (effective 11/1/13) ECC Electioneering Communication IEC Independent Expenditure Regarding a Candidate IEI Independent Expenditure Regarding an Issue MON Monetary(Not to a Candidate) PCW Petty Cash Withdrawn PCS Petty Cash Spent PPD Pre-paid Distribution REF Refund (Negative Amount Only) RMB Reimbursements TOA Transfer to Office Account(Disposition of Funds) (10) Amendment Type (required on amended reports) - To add a new (previously unreported) expenditure for the reporting period being amended, enter"ADD" in amendment type on a line with ALL of the required data. The sequence number for expenditures with amendment type "ADD" will start at one plus the number of expenditures in the original report. For example, amending an original M1 reports that had 75 expenditures, means the sequence number of the first expenditure having amendment type "ADD" will be 76; the second "ADD" expenditure would have sequence number 39. CAMPAIGN TREASURER'S REPORT SUMMARY (1) -J07)/7 g;/ ) D Tr 9°FIE Name ____ I]93/Z4 & 7#✓ OCT 12 2016 Address (number and street) lZif0//0. Z- /ice - cc -J o �C� City, State, Zip Code ' ❑ Check here if address has changed (3) ID Number: (4) Chick appropriate box(es): Ef Candidate Office Sought: _, .' ,(//'2 /G /--, ,Y/,t--%2 ❑ 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 /O / / /'' To /d / 17 / / Report Type: ec. / ❑'Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , , . ---- Expenditures $ , - Loans $ , , • _ Transfers to Office Account $ , Total Monetary $ • Total Monetary $ , • In-Kind $ , , (8) Other Distributions $ . -- (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date (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 haveexamined� this report and it is true, correct, and complete: / (Type name) /e 0/�/v��7�(/� (Type name) JO �f�J/r� ❑ Individual(only for IE L1 Treasurer ❑Deputy Treasurer Q Candidate ❑Chairperson(only for PC and PTY) or electioneering comm.) / ---r' ----- i. Air / X !� X Signatu Signature DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS Instructions for Campaign Treasurer's Report Summary (1) Name: full name of the candidate, political committee, party executive committee, electioneering communications organization, or individual making an independent expenditure or electioneering communication. (2) Address: the full address or post office box, city, state, and zip code. Check the box if the address has changed since the last report filed. (3) ID Number: identification number assigned by the filing officer. (4) Check the appropriate box(es). (5) Report Identifiers Cover Period: the dates this report covers (i.e., From 1/1/15 To 1/31/55). Important: use the appropriate cover period dates as published by the filing officer. Report Type: refer to the filing officer's calendar of reporting dates for the correct codes to be used for each reporting period. If report is for a special election add "S" in front of the report code (i.e., SG3). Check one of the appropriate boxes: Original: first report filed for this reporting period. Amendment: must summarize only contributions/fund transfers and expenditures/distributions being reported as additions or deletions. Read instructions for sequence numbers and amendment types on the back of Forms DS-DE 13A and 14A. Special Election Report: Important: once a special election report is filed, the entity is required to file all remaining reports due for the special election. (6) Contributions This Report: Cash and Checks: total amount for this reporting period. Loans: total amount for this reporting period. Total Monetary: sum of Cash and Checks and Loans. In-Kind: the fair market value of the in-kind contribution at the time it is given for this reporting period. (7) Expenditures This Report: Monetary Expenditures: total amount of monetary expenditures for this reporting period. Transfers to Office Account: total amount transferred to an office account by elected candidates only. Total Monetary: sum of Monetary Expenditures and Transfers to Office Account. (8) Other Distributions: the total amount of goods and services contributed to a candidate or other committee by a PC, ECO, or PTY. (9) TOTAL Monetary Contributions To Date: the amount of total monetary contributions to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (10) TOTAL Monetary Expenditures To Date: the amount of total monetary expenditures to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (11) Type or print the required officer's name and have them sign the report: Candidate report: treasurer and candidate must sign. ❑ PC report: treasurer and chairperson must sign. PTY report: treasurer and chairperson must sign. E ECO report: organization's treasurer must sign. C IE or EC report: individual must sign (this applies when an individual acts alone to make these expenditures) AMENDMENT REPORTS: An amendment report summary should summarize only contributions, expenditures, distributions, & fund transfers being reported as additions or deletions. Read the instructions for the sequence number & amendment type fields on the back of forms DS-DE 13, 14, 14A and 94. WAIVER OF REPORT Eii C C 0 W E-Th (Section 106.07(7), F.S.) OCT 13 2016 (PLEASE TYPE) l C6C1 OFFICE USE ONL Name Office Sought 1?✓ 4ZA. err. 1 7- /, ✓i�� ��//2 Address City State Zip Code DICandidate 0 Political Committee ❑ Party Executive Committee NOTE: This form does not apply to an electioneering communications organization(ECO). An ECO must file a report(not a waiver)that no reportable contributions or expenditures were made during the reporting period(s. 106.0703(6), F.S.). ❑ Check here if address has changed since last report. ❑ Check here if PC has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) ❑ MONTHLY REPORT ❑ PRIMARY ELECTION ❑ GENERAL ELECTION ❑ OTHER REPORT TYPE Indicate report# Indicate report# Indicate report# Indicate report type and# M P G as applicable: TERMINATION REPORT SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF �O// THROUGH X ��` 70//?/// 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.) Party Executive Committees: Treasurer and Chairman(s. 106.29(2), F.S.) Except as noted above for an ECO, 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. 06115) E CEIIV WAIVER OF REPORT D (Section 106.07(7), F.S.) OCT 2 0 2016 I] (PLEASE TYPE) L USEeNef— Jah'A Name Office Sought 99- / /1/‘,--G25/ tom= 4 c��f% 1- /=l --Z-742g Address City State Zip Code ri Candidate ❑ Political Committee ❑ Party Executive Committee NOTE: This form does not apply to an electioneering communications organization (ECO). An ECO must file a report(not a waiver)that no reportable contributions or expenditures were made during the reporting period(s. 106.0703(6), F.S.). Check here if address has changed since last report. I I Check here if PC has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) ❑ MONTHLY REPORT ❑ PRIMARY ELECTION ❑ GENERAL ELECTION ❑ OTHER REPORT TYPE Indicate report# Indicate report# Indicate report# Indicate report type and # M P G as applicable: TERMINATION REPORT SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF //'//6 THROUGH X7./- ,4"'" // 2� �‘ 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.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) Except as noted above for an ECO, 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. 06/15) CAMPAIGN TREASURER'S REPORT SUMMARY (1) Jahrt/ , ---. a� V Name D r= 1, (2) 39,7 7-,IP/a-2 e f/2- Address (number and street) J/ G �Zv OCT 2 2��6 ��� �.�A :/,-�� �� �/ City, State, Zip Code Check here if address has changed (3) ID Number: (4) Check appropriate box(es): ❑Candidate Office Sought: -, /,/f/j'/t /fl/ice l ❑ 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 .,7 / jj� / 4 To / 7 I . I Report Type: ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary .(:,c 9v Cash & Checks $ , , • Expenditures $ , , . Loans $ , , • Transfers to Office Account $ , Total Monetary $ , , - Total Monetary $ , In-Kind $ , , • (8) Other Distributions $ , , . (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date (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 name) _-f'> ,f/'// i,i% ' (Tyye name) --4717P1/ � 4/) ❑ Individual(only for IE DiTreasurer ❑ Deputy Treasurer pliCandidate ❑ Chairperson(only for PC and PTY) or electioneering comm.) X i X / / Signature Signature DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS Instructions for Campaign Treasurer's Report Summary (1) Name: full name of the candidate, political committee, party executive committee, electioneering communications organization, or individual making an independent expenditure or electioneering communication. (2) Address: the full address or post office box, city, state, and zip code. Check the box if the address has changed since the last report filed. (3) ID Number: identification number assigned by the filing officer. (4) Check the appropriate box(es). (5) Report Identifiers Cover Period: the dates this report covers (i.e., From 1/1/15 To 1/31/55). Important: use the appropriate cover period dates as published by the filing officer. Report Type: refer to the filing officer's calendar of reporting dates for the correct codes to be used for each reporting period. If report is for a special election add "S" in front of the report code (i.e., SG3). Check one of the appropriate boxes: ❑Original: first report filed for this reporting period. ❑Amendment: must summarize only contributions/fund transfers and expenditures/distributions being reported as additions or deletions. Read instructions for sequence numbers and amendment types on the back of Forms DS-DE 13A and 14A. Special Election Report: Important: once a special election report is filed, the entity is required to file all remaining reports due for the special election. (6) Contributions This Report: Cash and Checks: total amount for this reporting period. Loans: total amount for this reporting period. Total Monetary: sum of Cash and Checks and Loans. In-Kind: the fair market value of the in-kind contribution at the time it is given for this reporting period. (7) Expenditures This Report: Monetary Expenditures: total amount of monetary expenditures for this reporting period. Transfers to Office Account: total amount transferred to an office account by elected candidates only. Total Monetary: sum of Monetary Expenditures and Transfers to Office Account. (8) Other Distributions: the total amount of goods and services contributed to a candidate or other committee by a PC, ECO, or PTY. (9) TOTAL Monetary Contributions To Date: the amount of total monetary contributions to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (10) TOTAL Monetary Expenditures To Date: the amount of total monetary expenditures to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (11) Type or print the required officer's name and have them sign the report: Candidate report: treasurer and candidate must sign. ❑PC report: treasurer and chairperson must sign. PTY report: treasurer and chairperson must sign. ECO report: organization's treasurer must sign. IE or EC report: individual must sign (this applies when an individual acts alone to make these expenditures) AMENDMENT REPORTS: An amendment report summary should summarize only contributions, expenditures, distributions, & fund transfers being reported as additions or deletions. Read the instructions for the sequence number & amendment type fields on the back of forms DS-DE 13, 14, 14A and 94. CAMPAIGN TREASURER'S REPORT SUMMARY (1) /0/' 4/ ?Or 1Z) FF16 Name `' � VJ �' Q (2) gam/l / "13i�' %l�`� r------ --- ._ Address (number and street) 1 OCT 2 8 2016 (;4 " (?47/104-7t-XZ/t s Z.4 l I __ . City, State, Zip Code CCd -- ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): [Candidate Office Sought: (:::,V//C:/G /11/4:3)7//7'- ❑ 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 jC7 / /S / /6 To lt2 / 2/ / /6 Report Type: 66 [,Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , , . Expenditures $ , , ,- Loans $ , Transfers to Office Account $ . Total Monetary $ , • Total Monetary $ , In-Kind $ • (8) Other Distributions $ . (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ , ,764 . 4,, $ ' . (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 name) J 9 /,/ %'LJ '.1 j (Type name) JnG�/4/ /5d "5 ❑ Individual(only for IE ( Treasurer ❑ Deputy Treasurer IJCandidate ❑Chairperson(only for PC and PTY) or electioneering comm.) 0 x 7- - x Signature Signature '7 DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS in,\F © EllvE r WAIVER OF REPORT " (Section 106.07(7), F.S.) OCT 2 8 2016 !, 11\\ (PLEASE TYPE) Cco L1- OFFICE USE ONLY Ji"/9// r 1Z- Name Office Sought Address City State Zip Code .Candidate Q Political Committee 0 Party Executive Committee NOTE: This form does not apply to an electioneering communications organization(ECO). An ECO must file a report(not a waiver)that no reportable contributions or expenditures were made during the reporting period (s. 106.0703(6), F.S.). n Check here if address has changed since last report. _ Check here if PC has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) El MONTHLY REPORT PRIMARY ELECTION 0 GENERAL ELECTION fl OTHER REPORT TYPE Indicate report# Indicate report# Indicate report# Indicate report type and# M P G �j as applicable: n TERMINATION REPORT SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF ///5/i THROUGH /9/0/4 //2?-‘,/f/ 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.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) Except as noted above for an ECO, 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. 06/15) ECEEl \vil WAIVER OF REPORT L) � (Section 106.07(7), F.S.) I NOV 0 4 2016 (PLEASE TYPE) - L"c.v OFFICE USE ONLY JJ//f//C A// Go����G /� i /2 Name Office Sought Address City State Zip Code ❑ Candidate ❑ Political Committee ❑ Party Executive Committee NOTE: This form does not apply to an electioneering communications organization (ECO). An ECO must file a report(not a waiver)that no reportable contributions or expenditures were made during the reporting period (s. 106.0703(6), F.S.). Check here if address has changed since last report. ❑ Check here if PC has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) ❑ MONTHLY REPORT ❑ PRIMARY ELECTION 0/GENERAL ELECTION ❑ OTHER REPORT TYPE Indicate report# Indicate report# Indicate report# Indicate report type and# M P G as applicable: TERMINATION REPORT SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF //ZZ/4 THROUGH /// / X G� /// 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.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) Except as noted above for an ECO, 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. 06/15) CAMPAIGN TREASURER'S REPORT SUMMARY EF ILt729C51 Name D (2) 7?//a 7. FEB FEB 0 2 20 Address (number and street) 17 0Plz ��/,'P%/ /7 " - 2?ze sl City, State, Zip Code �' ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): Candidate Office Sought: COU/1/G ( M.: �72 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 /7 / / /7., To / / / / .7 Report Type: % 7 ❑ Original Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ Expenditures $ , , - 9 . a•-,7,— Loans Loans $ , , • Transfers to Office Account $ Total Monetary $ , , • Total Monetary $ , • In-Kind $ , , (8) Other Distributions $ , , (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ , ,/6:5' • 2 $ , , 77(/ . (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 name) .JO/��l/+ �� (T pe name) j9/44'/'741/ I=1 Individual(only for IE l/� Treasurer 1=IDeputy Treasurer Candidate ❑Chairperson(only for PC and PTY) or electioneering comm.) X 7_ 41- `-';'. .-27 _,Z_.------- Signature Signature , DS-DE 12(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name boy*/20/1/1) (2) I.D. Number (3) Cover Period /0 / ZZ / /6 through / / (4) Page 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 / Z/I G//G Ali. Ga0e7i 2//v y 7i0/9 s_//g/v/iC rte eff/2r0/0 PT//✓72/ a ()/W h//// /// A! Av /1/. & crux crr✓��, �zr,L� L fi,/v/� /e 3z9zo '/>y off'64E/t ci/✓/'i 2 2L ,42/IA/S� /// Z// /7 5vi2, sz?Li/mss /=�sT /fibs'/ qqyy,, / A7-F ,6 /11 ooi nv!�'lgi //G ?z2, . alci//h fo' 6995 Ol/ nas f. O(2 / / / / / / / / DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY (1) J D1�/i/goi✓J D RepE a44,€yiE Name (2) '9?/ j FEB 0 2 2017 Address (number and street) _ c4/PZ A Y/_ ,cam YY,ZO City, State, Zip Code n Check here if address has changed (3) ID Number: (4) Ch= k appropriate box(es): ® Candidate Office Sought: ' /VG/- /2//�,.i2 ❑ 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 / / To / 1 / /7 Report Type: 77,3i,/7 Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , , • Expenditures $ , , Vo . 99 Loans $ , • Transfers to Office Account $ . Total Monetary $ • Total Monetary $ In-Kind $ • (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ , /,65o . oo $ , , /,SSD e (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 name) ,Ja/--//1/ 3' AJ (Type name) _ ,,A/ / Aj9//.2) ❑ Individual(only for IE ]Treasurer ❑ Deputy Treasurer l Candidate ❑ Chairperson(only for PC and PTY) or electioneering comm.) / ' Signature Signature DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name Jl/1/1/ 7-0/1& / (2) I.D. Number / (3) Cover Period / I I through Z / / / / 7 (4) Page 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 093/G ', 7�'z/1/, l/�z 7;yz 5/6/044E- - 0 4p//'6/PA/A/4WXZ, FG /ova/ i✓fr/� /1/1&11/ 3 fC 707zo i01*gai0 / 4 - / m//7 /93/4.9,a-b// ' �a Z 20,0/i/ec4✓ /Yip/✓ /oo.9 O G4/,r- ,0i//i/ TV&//"/ S�4D G�/vil /Zo _ s-Y.q -g- o� j flN�,r/017'?" P,rYf/o v"r- /3d//`7 /.5, X75 �/ //1/1/ /f..0%z' j /41? /Z /' .z9S- ; 5.&'J G ‘A/W) /.1G / / / / / / / / / / DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES