Keller, Tom Edward - Seat 4(1)
(2)
CAMPAIGN TREASURER'S REPORT SUMMARY
Tom Keller
Name
1707 Algonquin Dr.
Address (number and street)
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
❑✓ Candidate Office Sought:
0 Political Committee (PC)
viA. 2_016
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT.
(3) ID Number:
Clearwater City Council - Seat 4
0 Electioneering Communications Org. (ECO)
0 Party Executive Committee (PTY)
0 Independent Expenditure (IE) (also covers an
individual making electioneering communications)
0 Check here if PC or ECO has disbanded
❑ Check here if PTY has disbanded
0 Check here if no other IE or EC reports will be filed
Cover Period: From 03/09/2018/
0 Original ❑ Amendment
(5) Report Identifiers
To 06/10/2018/ Report Type: TR
0 Special Election Report
(6) Contributions This Report
Cash & Checks $
Loans $
Total Monetary $ 0
In -Kind $
0
0
0
(7) Expenditures This Report
Monetary
Expenditures $ ,4 ,912,77
Transfers to
Office Account $
Total Monetary $ 4,912.77
(8) Other Distributions
0
(9) TOTAL Monetary Contributions To Date
$ , 14,275;00
(10) TOTAL Monetary Expenditures To Date
$ , 14,275;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 name) Kathy Watson
❑ Individual (only for IE 0 Treasurer
or election - : 'ng comm.)
X
Signature
0 Deputy Treasurer
DS -DE 12 (Rev. 11/13)
(Type name) Tom Keller
0 Candidate 0 Chairperson (only for PC and PTY)
X
nature
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Tom Keller (2) I.D. Number
(3) Cover Period 03/09/018 / through 06/101/2018 /
(4) Page 1 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
pe
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
04//201
Thomas Keller
1707 Algonquin Dr.
To close account
Reimburse personal
001
Clearwater, FL 33755
loan.
DIS
3784.66
Prior months
!/ mo7hs
Inkind adj.
posted as
NON-Monetary amount
Printed yard signs
MON
1,100.00
002
04/2201;
Service fees
Bank fees
003
CAN
27.07
04/23/2018
/ /
Custom Graphics of Tampa
6619 78th St., Ste. A
Riverview, FL 33578
Sales tax
CAN
1.04
004
/ /
/ /
/ /
/ /
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Tom Keller
03/09/2018 06/10/2018
(3) Cover Period / / through
(2) I.D. Number
(4) Page 1 of 1
(5)
Date
(7)
Full Name
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
/ /
/ /
/ /
/ /
/ /
/ /
/ /
b -np 1R /Rev
44144 --_ ------ --- -
R INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) Tom Keller
SUMMARY
RWEIVEDILY
MAP - ' 2016
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT.
Name
(2) 1707 Algonquin Dr.
Address (number and street)
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
(3)
Council
ID Number
- Seat 4
✓ Candidate Office Sought: Clearwater City
❑ 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 03/02/2018/ To 03/08/2018 Report Type: G7
Election Report
✓ Original ❑ Amendment ❑ Special
(6) Contributions This Report
Cash & Checks $, , 0 .
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , 2,230.05
Loans $, , 0 •
to
$, , .
Total Monetary $, 0
$, 2,2.30.05
In -Kind $, 0 .
(8)
$,
Other Distributions
0.
(9) TOTAL Monetary Contributions To Date
$ , 14,275,00
(10) TOTAL
Monetary Expenditures To Date
$, , 9,362;23
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Kathy Watson
to falsify a public record (ss. 839.13, F.S.)
and _complete:
(Type name) Tom Keller
• Individual (only for IE • Treasurer GI Deputy Treasurer
❑� Candidate Ij Chairperson (only for PC and PTY)
X
or election ering comm.)
1 �
_1./i.1
Signature /
Sign 1e
-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Tom Keller (2) I.D. Number
(3) Cover Period o3/02q018 / through 03/081/2018 /
(4) Page 1 of
1
(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
Type
(10)
Amendment
(71)
Amount
(6)
Sequence
Number
03/b6/2q�18
i/ //
Strategic Solutions of Florida
301 W. Platt St. #92
Tampa, FL 33606
Professional
fees,Print palm
cards and deliver
CAN
$2,230.05
001
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Tom Keller
03/02/2018
(3) Cover Period /
/
(2) I.D. Number
03/08/2018 1 1
through / / (4) Page of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
/
/
/
/
/
/
/
/
/
/
/
/
/
/
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Tom Keller'"
O
Name
(2) 1707 Algonquin Dr.
.. `; Ls Ls,'
Address (number and street)
Clearwater, FL 33755
'•
OFFICI,-L i.ECORDS AND
City, State, Zip Code
LEGIktTI\' E SRVCS DEPT.
❑ Check here if address has changed (3) ID Number:
(4)
Check
SI
appropriate box(es):
Candidate Office Sought: Clearwater City Council - Seat 4
❑ 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 02/23/2018/ To 03/01/20181 Report Type: G6
✓
Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ , , 0 .
(7) Expenditures This Report
Monetary
Expenditures $ , , 0.
Transfers to
Office Account $, , 0.
Loans $ , 0 •
Total Monetary $ 0
Total Monetary $, 0.
In -Kind $ 0 .
(8) Other Distributions
$ , , 0.
(9) TOTAL Monetary Contributions To Date
$ , , 14,275,00
(10) TOTAL Monetary Expenditures To Date
$ . , , 7,132,18
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Kathy Watson
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Tom Kbiler
• Individual (only for IE ■ Treasurer I7 Deputy Treasurer
or election ring comm.)
}
X /
0 Candidate ■ Chairperson (only for PC and PTY)
X .6.
Signature
Si ature
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Tom Keller
(3) Cover Period o2/23q018 / through 03/01//2018 /
(2) I.D. Number
(4) Page 1 of
1
(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)
Exper;diture
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Tom Keller
(3) Cover Period
02/23/718
/
03/01/2018
through /
(2) I.D. Number
/ (4) Page 1 of 1
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
/
/
/
/
/
/
/
/
/
/
/
/
/
/
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) Tom Keller
SUMMARY
9 lref'‘,Y
2. I 201
OFFICIAL RECORDS AND
1 FGISLATIVE SRVCS DEPT.
Name
(2) 1707 Algonquin Dr.
Address (number and street)EB
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
(3)
Council
ID Number:
- Seat 4
1 Candidate Office Sought: Clearwater City
❑ 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 02/16/2018/ To 02/22/2018/ Report Type: G5
Election Report
✓ Original ❑ Amendment ❑ Special
(6) Contributions This Report
Cash & Checks $ , , 0 .
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , , 0.
Loans $ , , 0 •
to
$ , , 0.
Total Monetary $ 0
$ , 0.
In -Kind $ , , 700,00
(8)
Other Distributions
$ , , 0.
(9) TOTAL Monetary Contributions To Date
$ , , 14,275,00
(10)
TOTAL Monetary Expenditures To Date
$ , , 7,132,18
(11) Certification
It is a first degree misdemeanor for any person
I certify that 1 have examined this report and it is true, correct,
(Type name) Kathy Watson
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Tom Keller
❑ Individual (only for IE ■ Treasurer O Deputy Treasurer
0 Candidate
0 Chairperson (only for PC and PTY)
�---
or electione:, 'ng comm.)
/ 1 1
X ,,
X eq.. / /, I ��
Signature
SJ•*ature
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Tom Keller
(3) Cover Period
2/16/2018
/
thrOU h 02/22/2018
9
(2) I.D. Number
/ (4) Page 1 of
1
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(6)
Occupation
(9)
Contribution
Type
(10)
In•':ind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
02/16/2018
/ /
Accent
2014 W. Horatio St.
Tampa, FL 33609
B
Printing
INK
Yard signs
700.00
001
/ /
/ /
/ /
/ /
/ /
/ /
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Tom Keller
(3) Cover Period o2/16/p18 / through 02/22//2018 /
(2) I.D. Number
(4) Page 1 of
1
(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
Type
(1 0)
Amendment
(11)
Amount
(6)
Sequence
Number
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) Tom Keller
SUMMARY
OFFICE USE ONLY`�
RECEIVED
FEE 2018
OFFICIAL RECORDS AND
Name
(2) 1707 Algonquin Dr.
Address (number and street)
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
(3)
Council
ISLATIVE SRVCS DEPT.
ID Num
- Seat 4
1 Candidate Office Sought: Clearwater City
❑ 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 02/09/2018/ To 02/15/2018 Report Type: G4
Election Report
1 Original ❑ Amendment ❑ Special
(6) Contributions This Report
Cash & Checks $ , , 0 .
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , , 0.
Loans $ 0 •
to
$, , 0.
Total Monetary $ , 0
$ , 0.
In-Kind $ , 0 .
(8)
Other Distributions
$ , , 0.
(9) TOTAL Monetary Contributions To Date
$ , 13,575 , 00
(10)
TOTAL Monetary Expenditures To Date
$ , , 7,132,18
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Kathy Watson
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Tom Keller
• Individual (only for IE ❑ Treasurer GI Deputy Treasurer
0 Candidate
X
■ Chairperson (only for PC and PTY)
or electio eering comm.
I,1A.
X ��
Signature
Si ture
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Tom Keller
(3) Cover Period o2/o9f2oia / through 02/15//2018 /
(2) I.D. Number
1 1
(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
Type
(1 0)
Amendment
(11)
Amount
(6)
Sequence
Number
/ 1
1
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Tom Keller
(3) Cover Period
02/09/2118
02/15/2018
/ through /
(2) I.D. Number
/ (4) Page 1 of
1
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
/
/
/
/
/
/
/
/
/
/
/
/
/
/
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) Tom Keller
SUMMARY
OFFICE USE ONLY
RECEIVED
r r:13 ',. '' 2016
OFFICIAL RECORDS AND
Name
(2) 1707 Algonquin Dr.
Address (number and street)
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
(3)
Council
tSS
ID Numbe�IS(�IrIVt I<VC.00'1.
- Seat 4
✓ Candidate Office Sought: Clearwater City
❑ 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 01/26/2018/ To 02/08/2018/ Report Type: G3
Election Report
1 Original ❑ Amendment • Special
(6) Contributions This Report
Cash & Checks $ , , 0 .
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , , 25.40
Loans $ 0 •
to
$ , , 0.
Total Monetary $ , 0
$ , 25.40
In-Kind $ 0 .
(8)
Other Distributions
$ , , 0.
(9) TOTAL Monetary Contributions To Date
$ , 13,575 , 00
(10)
TOTAL Monetary Expenditures To Date
$ , , 7,132:18
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Kathy Watson
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Tom Keller
❑ Individual (only for IE 0 Treasurer 0 Deputy Treasurer
GI Candidate
0 Chairperson (only for PC and PTY)
or electioneering comm.)
X
X_gi
Signature
Si_)i ture
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Tom Keller
01/26/2018
(3) Cover Period /
02/08/2018
(2) I.D. Number
/ through / / (4) Page 1 of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
/
/
/
/
/
/
/
/
/
/
/
/
/
/
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name Tom Keller
(3) Cover Period 01/26/018 / through 02/08//2018 /
(2) I.D. Number
(4) Page 1 of
1
(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
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
01///20748
Official Records and Legislative
Services
City of Clearwater
112 S. Osceola Avenue
Clearwater, FL 33756
Verification of
signatures
contained on
petitions
CAN
25.40
1
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) Tom Keller
SUMMARY
OFFICE USE ONLY
RECEIVED
FEE, ; n 2018
OFFICIAL RECORDS AND
Name
(2) 1707 Algonquin Dr.
Address (number and street)
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
(3)
Council
F(��'j�� ATNE SRVCS DEPT.
ID rrl
- Seat 4
✓ Candidate Office Sought: Clearwater City
❑ 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 01/12/2018 To 01/25/2018/ Report Type: G2
Election Report
❑ Original 1 Amendment ❑ Special
(6) Contributions This Report
Cash & Checks $ , , 0 .
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , , 0.
Loans $ 0
to
$ , , 0.
Total Monetary $ , 0 •
$ ,0.
'
In -Kind $ , , 0 .
(8)
Other Distributions
$, , 0.
(9) TOTAL Monetary Contributions To Date
$ , 13,575 .00
(10)
TOTAL Monetary Expenditures To Date
$ , , 7,106.7$
(11) Certification
It is a first degree misdemeanor for any person
I certify that 1 have examined this report and it is true, correct,
(Type name) Kathy Watson
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Tom Keller
■ Individual (only for IE ■ Treasurer I] Deputy Treasurer
❑� Candidate
X
• Chairperson (only for PC and PTY)
or electi.i eering comm.)
x /» ,
.�i!C/
Signature 0
Si ature
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name Tom Keller (2) I.D. Number
(3) Cover Period of/12/bola / through o1/25//2o18 /
(4) Page 1 of
1
(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
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Tom Keller
(3) Cover Period
01/12/718
(2) I.D. Number
01/25/2018 1
through / / (4) Page of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
/
/
/
/
/
/
/
/
/
/
/
/
/
/
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Tom Keller
Name
(2) 1707 Algonquin Dr.
Address (number and street)
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
p Candidate Office Sought:
RErpE\ NLY
JAN 2e 2018
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT.
(3) ID Number:
Clearwater City Council - Seat 4
❑ Political Committee (PC)
O Electioneering Communications Org. (ECO)
O Party Executive Committee (PTY)
O Independent Expenditure (IE) (also covers an
individual making electioneering communications)
0 Check here if PC or ECC has disbanded
0 Check here if PTY has disbanded
0 Check here if no other IE or EC reports will be filed
(5) Report Identifiers
Cover Period: From 01/1/2/2018 To 01/25/2018/
✓❑ Original 0 Amendment
0 Special Election Report
Report Type: G2
(6) Contributions This Report
Cash & Checks $
Loans $
Total Monetary $
In -Kind $
(7) Expenditures This Report
Monetary
Expenditures
Transfers to
Office Account $
Total Monetary $
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date
$ 13,575 .00
(10) TOTAL Monetary Expenditures To Date
$ , , 7,106.7$
(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) Kathy Watson
❑ Individual (only for IE 0 Treasurer 0 Deputy Treasurer
or electio9eering comm.)
X
Signature
DS -DE 12 (Rev. 11/13)
(Type name) Tom Keller
21 Candidate
X
Si
0 Chairperson (only for PC and PTY)
`ire
SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Tom Keller
01/12/2018
(3) Cover Period /
01/25/2018
/ through /
(2) I.D. Number
(4) Page
1
of
FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
(7)
Full Name
Contributor
Type
(g)
Occupation
(9)
Contribution
Type
(10)
In-kind
Desc:ri•tion
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
/ /
/ /
/ /
/ /
/ /
/ /
/ /
ne_ne 44 /Co-..
•.,.n. --- --
FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name Tom Keller
(3) Cover Period 01/12/bo18 / through 01/25//2018 /
(2) I.D. Number
(4) Page 1 of
1
(5)
Date
(6)
Sequence
Number
(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
Type
(10)
Amendment
Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) Tom Keller
SUMMARY
OFFICE USE ONLY
RECEIVED
.N ` 9 20 18
OFFIck REKt7RPS ANS?
Name
(2) 1707 Algonquin Dr.
Address (number and street)
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
(3)
Council
IKs(5LA-11 Dior
ID Number:
- Seat 4
1 Candidate Office Sought: Clearwater City
❑ 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 01/01/2018 To 01/11/2018/ Report Type: G1
Election Report
✓ Original ❑ Amendment ❑ Special
(6) Contributions This Report
Cash & Checks $ -0-,
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , 4736.64
Loans $
to
$.
Total Monetary $ •
$ , 4,736.64
In -Kind $ •
(8)
$
Other Distributions
(9) TOTAL Monetary Contributions To Date
$ , 13,575 .00
(10) TOTAL
Monetary Expenditures To Date
$ , , 7,106.7$
(11) Certification
It is a first degree misdemeanor for any person
certify that I have examined this report and it is true, correct,
(Type name) Kathy Watson
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Tom Keller
❑ Individual (only for IE ❑ Treasurer El Deputy Treasurer
or electioneering comm.)
a
X
El Candidate 0 Chairperson (only for PC and PTY)
X _�
Sign ture
Sig► !ure
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Tom Keller
(3) Cover Period min/pis / through 01/111,2018 /
(2) I.D. Number
(4) Page 1 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
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
01/09/201/
Strategic Solutions of Florida
301 W. Platt Street
Professional fees
001
Tampa, FL 33606
CAN
2000.00
01/09/2018
Strategic Solutions of Florida
301 W,=. Platt Street
Tampa, FL 33606
Professional fees,
Logo, yard signs,
Website set up and
hosting.
CAN
2736.64
002
/ /
/ /
/ /
/ /
/ /
/ /
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) Tom Keller
SUMMARY
OFFICE USE ONLY
Name
(2) 1707 Algonquin Dr.
Address (number and street)
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
(3)
Council
ID Number:
- Seat 4
✓ Candidate Office Sought: Clearwater City
❑ 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 01/01/2018 To 01/11/2018i Report Type: G1
Election Report
1 Original ❑ Amendment ❑ Special
(6) Contributions This Report
Cash & Checks $ -0- , , •
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , 4736.64
Loans $
to
$.
Total Monetary $ •
$ , 4,736.64
In -Kind $ •
(8)
$
Other Distributions
(9) TOTAL Monetary Contributions To Date
$ , 13,,575 .00
(10) TOTAL
Monetary Expenditures To Date
$ , , 7,106.7$
(11) Certification
It is a first degree misdemeanor for any person
certify that I have examined this report and it is true, correct,
(Type name) Kathy Watson
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Tom Keller
❑ Individual (only for IE 0 Treasurer 0 Deputy Treasurer
or electioneering comm.)
X 4_wml
0 Candidate 0 Chairperson (only for PC and PTY)
X
Sign ture
Sig r:lure
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Tom Keller (2) I.D. Number
(3) Cover Period 01/01qo18 / through 01/11//2018
(4) Page 1 of
1
(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
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
01/09/201/
Strategic Solutions of Florida
301 W. Platt Street
Tampa, FL 33606
Professional fees
CAN
2000.00
001
o'/o J2018
Strategic Solutions of Florida
301 W,=. Platt Street
Tampa, FL 33606
Professional fees,
Logo, yard signs,
Website set up and
hosting.
CAN
2736.64
002
/ /
/ /
/ /
/ /
/ /
/ /
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) Tom Keller
SUMMARY
OFFICE USE `R ONLY
�-- spy aa.
JAN ; J1R
OFFICIAL ,; t — DS ANn
Name
(2) 1707 Algonquin Dr.
Address (number and street)
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed(3)
(4) Check appropriate box(es):
Council
Iv'L )7`\'CS DEPT.
ID1�.
- Seat 4
/ Candidate Office Sought: Clearwater City
❑ 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 12/1/2017 / To 12/3/1/2017/ Report Type: M12
I� Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ , , 400.00
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ 0 .
Loans $
to
$ , , .
Total Monetary $ , , 400.00
$ 0 ,
In -Kind $ , , 125.00
(8)
$
Other Distributions
-0- , -tlz- •
(9) TOTAL Monetary Contributions To Date
$ , 13,575 .00
(10) TOTAL
Monetary Expenditures To Date
$ , , 2,370. . 14
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Kathy Watson
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Tom Keller
■ Individual (only for IE ■ Treasurer El Deputy Treasurer
GI Candidate ■ Chairperson (only for PC and PTY)
or electioneering comm.)
)9(6/4-1
X (f / ]� y
Signature Inature
-DE 12 (Rev. 11/13
SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Tom Keller
(3) Cover Period
12/01/2017
/
(2) I.D. Number
12/31/20171 1
through / / (4) Page of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
12/13/2017
/ /
Andrew Stinnette, pa
597 Main Street
Dunedin, FL 34698
B
Attorney
CHE
400.00
001
12/31/2017
/ /
Accent
3014W. Horatio Street
Tampa, FL 33609
b
Printing
INK
Yards signs
125.00
002
/ /
/ /
/ /
/ /
/ /
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) Tom Keller
SUMMARY
oL
DEC U lr f
OFFICIAL RECORDS AND
LEGISLATIVE SR CS DEPT.
Name
(2) 1707 Algonquin Dr.
Address (number and street)
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
(3)
Council
ID Numbe, •
- Seat 4
✓ Candidate Office Sought: Clearwater City
❑ 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 11/01/2017i To 11/30/2017i Report Type: MI 1
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ 1,00,0.00 , •
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ 2,35,4.00 , .
Loans $ , , •
to
$ .
Total Monetary $1,00,0.00 , .
$ 2,354.00 .
In -Kind $ , , •
(8)
Other Distributions
$ , .
(9) TOTAL Monetary Contributions To Date
$ 13,050,00,•
(10) TOTAL
Monetary Expenditures To Date
$ 2,370.1,4 , •
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Kathy Watson
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Tom Keller
■ Individual (only for IE ■ Treasurer 0 Deputy Treasurer
❑r Candidate j_] Chairperson (only for PC and PTY)
X .
or elections ring comm.)
X _Adjtflir a/17,t.-/
Signa ure
Si. ature - _
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Tom Keller
(2) I.D. Number
11/01/2017 11/30/2017 1
(3) Cover Period / / through / / (4) Page of
1
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
11/15/2017
/ /
Rocker Corporation
3014 W. Horatio St.
Tampa, FL 33609
B
Real Estate
CHE
1,000.00
001
/ /
/ /
/ /
/ /
/ /
/ /
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Tom Keller
(3) Cover Period 11/01/017 / through 11/30//2017 /
(2) I.D. Number
(4) Page. 1 of
1
(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
Type
(10)
Amendment
(11)
Amount
(S)
Sequence
Number
11/03{201/
!!
Strategic Solutions of Florida
Professional Fees
Voter data system
CAN
2,354.20
1
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) Tom Keller
SUMMARY
ORFfrAMDT
NOV 0�91
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT,
Name
(2) 1707 Algonquin Dr.
Address (number and street)
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
(3)
Council
ID Number:
- Seat 4
✓ Candidate Office Sought: Clearwater City
❑ 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 10/01/2017/ To 10/31/2017/ Report Type: M 10
Original d Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ , 2 , 050 .00
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ . , , 15 . 94
Loans $ , 10 , 000 .00
to
$ , , ,
Total Monetary $ , 12 , 050 .00
$ ,15. 94
r
In -Kind $
(8) Other
$
Distributions
.
(9) TOTAL Monetary Contributions To Date
$ , 12 , 050 , 00
(10) TOTAL
$
Monetary Expenditures To Date
, - 15 , 94
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Kathy Watson
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Tom Keller
❑ Individual (only for IE ■ Treasurer ❑� Deputy Treasurer
E Candidate
X
■ Chairperson (only for PC and PTY)
or electio ering comm.)
at -17._X i
Signature
Si ature
-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Tom Keller
(3) Cover Period
10/01/2017
through
10/31/2017
9
(2) I.D. Number
1
1
/ (4) Page of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In -Kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
Metropolitan Media Co
10/10/2017
3014 W. Horatio St.
/ /
Tampa, FL 33609
001
B
Outdoor Adv.
CHE
1,000.00
Tom Keller
10/10/20107
1707 Algonquin Drive
/
Clearwater, FL 33755
002
5
LOA
10,000.00
James W. Shaw
10/23/2017
2742 Burning Tree Ln
/
Clearwater, FL 33761
003
I
Claims Adj.
CHE
500.00
10/30/2017
Jay Keller Jr
502
/ /
Manatee Drive
Ruskin, FL
004
I
Sales Rep.
CHE
250.00
Walter Burnside P.A.
10/31/2017
Attorney at Law
/ /
304 S. Westland Ave.
005
Tampa, FL 33606
B
Law office
CHE
300.00
/ /
/ /
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Tom Keller
(3) Cover Period to/0l/�017 / through 10/31//2017 /
(2) I.D. Number
(4) Page 1 of
1
(5)
Date
(7)
Full Name
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Expenditure
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
10/23/201/
��
Custom Graphics of Tampa
6619 78th St., Ste. A
Riverview, FL 33578
Badges
1
CAN
15.94
/ /
/ /
/ /
/ /
•
/ /
/ /
/ /
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
y
CAMPAIGN TREASURER'S REPORT
(1) Tom Keller Campaign
SUMMARY
O
NOV 217
OFFICIAL RECORDS AND
LEGISLATIVF SRV)EPT
Name
(2) 1707 Algonquin Dr.
Address (number and street)
Clearwater, FL 33755
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
(3)
- Seat
ID Number:
4
✓ Candidate Office Sought: Commissioner
❑ 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 10/0A/2017/ To 10/3/1/2017/ Report Type: M 10
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ 2 , 050. 00
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$, , 15 . 94
Loans $ , 10 , 000 .00
to
$ ,
Total Monetary $•
$ .
In -Kind $, •
(8)
$.
Other Distributions
(9) TOTAL Monetary Contributions To Date
$ , 12 , 050 , 00
(10)
TOTAL Monetary Expenditures To Date
$15 94
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Kathy Watson
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Tom Keller
■ Individual (only for IE • Treasurer 0 Deputy Treasurer
El Candidate D Chairperson (only for PC and P1 Y )
or electioneering comm.)
.
— _
Signature /
. gnature
DS -DE 12 (Rev. 11/13)
5 7E REVERSE FOR INSTRUCTIONS
f
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Tom Keller Campaign (2) I.D. Number
(3) Cover Period 10/01/017 / through 1o/31//2017 /
(4) Page 1
1
(g)
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
Type
(1 0)
Amendment
(11)
Amount
(6)
Sequence
Number
10/23201/
Custom Graphics of Tampa
6619 78th St., Ste. A
Riverview,
Badges
FL 33578
CAN
15.94
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
s ',
•
(1) Name
•.
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
Tom Keller Campaign
(3) Cover Period
10/01/2017
/
10/31/2017
through /
(2) I.D. Number
/ (4) Page 1 of 1
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(1 1)
Amendment
(12)
Amount
(6)
Sequence
Number
10/10/2017
Metropolitan Media Co.
3014 W. Horatio Street
/ /
Tampa, F1 33609
001
B
CHE
1,000.00
Tom Keller
10/10/2017
1707 Algonquin Drive
/ /
Clearwater, F1 33755
002
S
LOA
10,000.00
James W. Shaw
10/23/2017
2742 Burning Tree Ln
/ /
Clearwater, FL 33761
I
CHE
500.00
10/30/2017
Jay Keller Jr
/ /
502 Manatee Drive
Ruskin, FL 33570
I
CHE
250.00
Walter Burnside P.A.
10/31/2017
/ /
Attorney at Law
304 S. Wstland Ave.
Tampa, FL 33606
B
CHE
300.00
/ /
/ /
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer 122Z•iavow9_.....Laiin the cam ai n account.
L
ri n't 04 '''',ilt?
...
I ', 11 , ,_ .2, v. -,, —H.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES): i
Er Initial Filing of Form Re-filing to Change: [2( Treasurer/Deputy Depository Office Party
2. Name of Candidate (in this order: First, Middle, Last)
)'&J e,'
3. Address (include post office box or street, city, state, zip
code)
1-20Q illgoAquin) lOr,
e ) &72tr- A,'Prj 'Cr I 7-
4. Telephone
( 3 2- --) ) 3-3/- - cici 9
5. E-mail address
"ro/141k 6 Al c.r r v AUte-4 , C o an
6. Office sought (include district, circuit, group number)
z--i
7. If a candidate for a non • artisan office, check if
applicable:
fl My intent is to run as a Write-In candidate.
8. If a candidate for a .artisan office, check block and fill
in name of party as applicable: . My intent is to run as a
Party candidate.
El Write-In J No Party Affiliation fl
9. I have appointed the following person to act as my fl Campaign Treasurer Deputy Treasurer
10. Narrle of Treasurer or Deputy Treasurer
q wArsofj
11. Mailing Address
3/f7 SAIME-fe__ i 100SE_ bett2t—
12. Telephone
( g1-5 )767- /99
13. City
()WAD
14. County 15. State
1■&_i_Sett ---7—
16. Zip Code
AO
17. E-mail address
_ illill An.* t)eir%"1 2C4.A)--1
18. I have designated the following bank as my Primary Depository • Secondary Depository
19. Name of Bank
C e. N Ter ST- Arc- 6,4/v i<
20. Address
1-108 ..s- .mAcoill
21. City City
-Pt NY M i
22. County
II--; lickui-
23. State
/%9 -
24. Zip Code
3 360 el
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date
26. Signature of Candidate
x e
27. Treasurer's Acceptance of Appointment (fill he blanks and check the appropriate block)
I, kkgei WPRK-OQ , do hereby accept the appointment
(Please Print or Type Name)
designated above as: J Campaign Treasurer n Deputy Treasurer.
r) x 0/Mar
10 /Z+ . MIVAil MA.. 0
4
..4
D Signature of Cam ,aign Treasurer or Deputy Treasurer
e
DS-DE 9 (Rev. 10110)
Rule 1S-2.0001, F.A.C.
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Er Initial Filing of Form Re- filing to Change: ❑ Treasurer /Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last)
a//Y\ E hw - ll e-r
3. Address (include post office box or street, city, state, zip
code) /7o17 /4'IgoNgv,A) /0i^ ,
re47 e-f- E/ 33 75 .
4. Telephone
5. E -mail address
6. Office sought (include district, circuit, group number)
SeRtr q
7. If a candidate for a non • artisan office, check if
applicable:
❑ My intent is to run as a Write -In candidate.
8. If a candidate for a partisan, office, check block and fill in name of party as applicable: My intent is to run as a
❑ Write -In ❑ No Party Affiliation ❑ Party candidate.
9. I have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
- T o / 1 /<'e 11 'e,,-
11. Mailing / g Adddrress
1 - / 0 - A. I OA)
O /&/9-1,-/--- /
(.' 1 /V O r c � /1-7 - /
12. Telephone
(7 27) 6' 3 i 2,4-69 ri
13. City
eie 4
14. ounty
�Y1 e///+-5
15. State
F- %,
16. Zip Code
3 "7_S .S
17. E -mat address
. Al g ine,-)13 c4', cv
18. I have designated the following bank as my ❑ Primary Depository ❑ Secondary Depository
19. Name of Bank
0 e. / re(J)re- % 1.174 1 e
1 20. Address
f; .S rvit9c P; II l' h-- --
21. City
1-1'! 4
22. County
N-;//‘A.---/4
23. State
/t. /il
24. Zip Code
3 34 nq ,
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date
X04 /2 -a /-7
26. Signature of Candidate
X
27. Treasurer's Acceptance of Appointment (fill i e blanks and check the appropriate block)
I, , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer I] Deputy Treasurer.
/ 2' AL- % 2-e/ -7 X ,,„, ,,/._,'''-_______-
Date S' re of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S- 2.0001, F.A.C.