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HomeMy WebLinkAbout2017 - M4- Campaign Treasurer Report – DS-DE 12, DS-DE 13, DS-DE 13A, DS-DE 14, DS-DE 14A & DS-DE 94 - Michelle J GomezCAMPAIGN TREASURER'S REPORT SUMMARY l>6 &V OFFICE USE ONLY Name (2) r-i 0 WO® (,AfU?d (b c vJI, , Address (number and street) yam �M I°t a ram Ft- S 0 E2 o ;! City, State, Zip Code c ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): n ,— [Candidate \sSa j ' r 1— Z Office Sought: M N•l o ar -� 0 „ftC-r&C iS ❑ 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 y / f / To 7 / j O / ) 'j Report Type: 7 M y ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ % , • ) Expenditures $ Sd (s Z Loans $ > /-)) - -7 Transfers to Office Account $ Total Monetary $ , � � �� • -7�% Total Monetary $ , In -Kind $ (8) Other Distributions $ • (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expend' ures 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 thi report and it is true, correct, and complete: (Type name)/r �6ij� I 1(TYp name) ❑ Individual (only for IE Treasurer [IDeputy Treasurer Candidate ❑ Chairperson (only for PC and PTY) or election ing cc m.) X X t Signatulf 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 — ITEMIZED CONTRIBUTIONS (1) Name �1C�il�e �� �a (2) I.D. Number (3) Cover Period / ( / I-7 through T/ � / �` l (4) Page of (5) (7) (8) (9) (10) (11) (12) Date Full Name (Last, Suffix, First, Middle) (6) Sequence Street Address & Contributor Contribution In -kind Number City, State, Zip Code Occupation Type Description Amendment Amount -Type 17 13 0 "'(v A C b 360 �./ 2,y / 1'7 Q.zt l l��kb UU wrr% c l Z L U)oj 6.1js.N S L o A 5 bo 3 L MS 11 4/ 3 ► ,L �� 3. �,�: / 49)b Wtzh\0 - S �n A 3 c�wruu�t. � 333 j � 4110 woos_btj T„,,rrQc fi-33311 4 15 7.41 DS-DE 13 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 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) CAMPAIG TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name J • [� S+ & , t= (2) I.D. Number (3) Cover Period Of through//� (4) Page of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure p Type (10) Amendment (11) Amount (6) Sequence Number 4wtc,�rrc r>JhnrI�rc�ts+� 4 0• �2 b V i� /1 V�4� 0,1 I 3 �t � ct�K C t�CX I�9.� L� E -?W15 4A mv, Z `Slo C6MPc.%c C S DS-DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 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/DayNear). (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 Parteffective 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 PettyCash Withdrawn PCs PettyCash 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 (1) Name H whe-1 ..rayle-'4 (3) - ITEMIZED DISTRIBUTIONS (2) I.D. Number Cover Period '4/ 1 / 1'-:I- through ( / 3 0 /aolq (4) Page I of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Related Expenditures (10) Amendment (11) Amount (12) Distribution Type (6) Sequence Number DS-DE 14A (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 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 CAMPA GN TREASURER'S REPORT (1) Name CM, ,J . hoc-,-o-t (3) Cover Period 4 / I /nthrough - FUND TRANSFERS (2) I.D. Number (4) Page ' of (5) Date (7) Name of Financial Institution Street Address & City, State, Zip Code (8) Transfer Type (9) Nature of Account (10) Amendment (11) Amount (6) Sequence Number DS-DE 94 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT — FUND TRANSFERS (1) Type candidate's full name or name of the political committee (PC), committee of continuous existence (CCE) or party executive committee (PTY). (2) Type identification number assigned by the Division of Elections. (3) Type cover period dates (e.g., 7/1/03 through 9/30/03). (See Calendar and Election Dates for appropriate cover periods.) (4) Type page numbers (e.g., 1 of 3). (5) Type date of fund transfer (Month/DayNear). (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 Division and for reporting amendments. For example, a Q1 report having 2 fund transfers would use sequence numbers 1 thru 2. The next report (Q2), comprised of 4 fund transfers would use sequence numbers 1 thru 4. Fund transfers on amended Q1 reports would begin with sequence number 3 and on amended Q2 reports would begin with sequence number 5. See the Amendment Type instructions below. (7) Type full name and address of financial institution (including city, state and zip code). (8) Enter Transfer Type using one of the following codes: DESCRIPTION I CODE Transfer FROM identified account to campaign account F Transfer TO identified account from the campaign account T (9) Nature of Account (e.g., certificate of deposit, money market, etc...) (10) Amendment Type (required on amended reports) - To add a new (previously unreported) fund transfer for the reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data. The sequence number for fund transfers with amendment type "ADD" will start at one plus the number of fund transfers in the original report. For example, amending an original Q1 report that had 75 fund transfers, means the sequence number of the first fund transfer having amendment type "ADD" will be 76; the second "ADD" fund transfer would be 77, etc. When amending an original Q2 report that had 40 fund transfers, the sixth "ADD" fund transfer would have sequence number 46. To correct a previously submitted fund transfer use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the fund transfer to be corrected. In combination with the report number being amended, this sequence number will identify the fund transfer 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. Assign the sequence number as described above. (11) Type amount of fund transfer.