(1) Christine Hoffman Name CAMPAIGN TREASURERS REPORT SUMMARY REG (2) 1026 13th St. N. JUL 2 9 2016 Address (number and street) 32250 City, State, Zip Code City Clerk D Check here if address has changed (3) ID Number: NIA (4) Check appropri ate box(es): I 0 Candidate Office Sought: D Political Committee (PC) D Electioneering Communications Org. (ECO) D Party Executive Comm ittee (PTY) D Independent Expenditure (I E) (also covers an individual makin g electioneering commun ications) et!)y City of Jacksonville Beach - At Large Seat 1 D Check here if PC or ECO has disbanded D Check here if PTY has disbanded D Check here if no other IE or EC reports will be filed (5) Report Identifiers Cover Period: From 07 I 09 I 16 To 071 22 I 16 Report Type: 2016-P3 -- - - - - -- -- - - 0 Original D Amendment D Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks 10,800 00 Expenditures 00 00 - - -- -- -- -- -- -- -- Loans Transfers to Office Account -- -- - - - - Total Monetary -- -- - - - - In-Kind -- - - - - -- -- - - -- -- Total Monetary 00. 00 -- -- - - -- (8) Other Distributions -- -- -- -- (9) TOTAL Monetary Con.tributions To (10) TOTAL Monetary Expenditures To 16 229 71 -- -- -- -- 1,484. 94 ( 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 exam ined th is report and it is true, co rrect, and complete: (Type name) Matthew C. Bothwell (Type QRme) Christine Hoffman 0 Individual (only for IE 0 Treasurer I 0 Deputy Treasurer 0 Ca id id, ~ Ch"" (ooly Im ~c " PTY) :,,oct,oo[)jf;ll / x \ j Signature S i gnat~ lj OS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
(3) Cover Period 07 I 09 I 2016 through 07/ 22 / 2016 (4) PaQe 1 of 3 (5) (7) (8) (9) (10) (11) (12) (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In-kind Number City, State, Zip Code Type Occupation Type Description Amendment Amount 07/07/2016 Bell & Roper, P.A. 2707 E. Jefferson St. B Attorney CHE 1,000.00 Orlando, FL 32803 1 07/08/2016 Brown & Brown of FL Inc. P.O. Box2412 B Insurance CHE 1,000.00 Daytona Beach, FL 32115 2 07/08/2016 George A. Helm Ill, P.A. P.O. Box 958464 B Attorney CHE 500.00 Lake Mary, FL 32795 3 07/08/2016 USIS P.O. Box 616648 B Insurance CHE 1,000.00 Orlando, FL 32861 4 07/112016 Public Risk Underwriters of Florida, Inc. B Insurance CHE 1,000.00 P.O. Box 958455 5 Lake Mary, FL 32795 Roberts, Reynolds, 07/11/2016 Bedard & Tuzzio, PLLC 470 Columbia Dr B Attorney CHE 1,000.00 Building C 6 W. Palm Beach, FL 33409 07/12/2016 Brown & Brown, Inc. PO Box 2412 B Insurance CHE 1,000.00 Daytona Beach, FL 32115 7 07/12/2016 Preferred Gov. Claim Solutions, Inc. B Insurance CHE 1,000.00 P.O. Box 958456 8 Lake Mary, FL 32795 DS-DE 13 (Rev. 08/03)
(3) Cover Period 07/ 09 / 2016 through 07/ 22 / 2016 (4) Page 2 of 3 (5) (7) (8) (9) (10) (11) (12) (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In-kind Number Citv, State, Zio Code Type Occupation Tvoe Description Amendment Amount 07/1 2/2016 William G. Warner PO Box 1820 I Attorney CHE 500.00 Panama City, FL 32402 9 07/12/2016 Timothy M. Warner 812 Balboa Ave. I Attorney CHE 500.00 Panama City, FL 32401 10 07 /12/2016 William J. Carter 1884 Nightfall Dr. I Business CHE 250.00 Neptune Beach, FL Owner/Arts 11 32666 & Crafts 07/1 4/20 16 John C. Schmidt 55 San Juan Dr. I Retired CHE 500.00 Ponte Vedra Beach, FL 12 32082 07/15/2016 Works of Tab, LLC 333 N. 1st St. N. STE 100 B Restaurant CHE 250.00 13 7/15/15 Works of B and L LLC 333 1st St. N. STE 150 B Restaurant CHE 250.00 14 32250 7/18/2016 Lindsey Godfrey 1026 13th St. N. I CHE 50.00 15 32250 7/19/2016 Helen Dixon Coppedge 24272 Marsh Landing I Retired CHE 500.00 Parkway 16 Ponte Vedra, FL 32082 DS-DE 13 (Rev. 08103)
(3) Cover Period 07 I 09 I 2016 through 07 I 22 I 2016 (4) Page 3 of 3 (5) (7) (8) (9) (1 0) (11) (12) (6) (Last, Suffix, First, Midd le) Sequence Street Address & Contributor Contri bution In-kind Number Citv, State, Zio Code Tvpe Occupation Type Description Amendment Amount 07/1 9/20 16 Walter Dickinson 5187 Dixie Landing Dr I Retired CHE 500.00 Jacksonvil le, FL 32224 17 \ OS-DE 13 (Rev. 08/03)
CAMPAIGN TREASURERS REPORT - ITEMIZED EXPENDITURES (1) Name Christine Hoffman (2) l.d. Number ---N"""/A~----- (3) Cover Period 07 /~/ 2016 through 07 l_ll l--1ql.q_ (4) Page...,:.1 of 1 (5) (7) (8) (9) (10) (11) Purpose (6) Sequence (Last, Suffix, First, Middle) Street (add office sought if Number Address & contribution to a Expenditure City, State, Zip Code candidate) Type Amendment Amount I I OS-DE 14 (Rev. 08/03)