Petition ReceiptM1�DMADE
Miami -Dade Elections Department
2700 NW 87th Avenue
Miami, Florida 33172
305-499-8363
Petition Drop -Off Receipt
(To be -completed when receiving petitions from Governmental Agency or Committee)
�C�l� a—• Vt. s has surrendered to Miami -Dade Elections Department
ame of Representative
6-0
Petitions for
Quantity reported
Candidate/initiative
NOTE: Quantity reported is not official until counted by Elections staff. You will be notified if the
official count does not match quantity reported.
Provide the following for the Candidate or Initiative contact person in case we need additional
information: �1
r-1'9 d o fl(� z nc'sl at ✓�2
2 Ica n c, c\c s MOM tno/ $
Phone # Email )Mailing Address
Petitions'surrendered by: (Governm al Ag cy or Co ittee taft)
Print Name Si atu re— Date
Received by: (Miami -Dade Elections Department Sta
u�
Print Name A , , ' nature Date
1H3Wi,1(*,-'3C Sti011
U .0 Wd E— e8V14 SH9
DATE STAMP:
'`Pro�
.da-aletei cnp;�
_
OFFICIAL RECEIPT %a 5D d:�--
No'
M®ZM=ADE MIAMI-DADE COUNTY-FLORIDA
8053564
RECEIVED FROM/t%.S
DATE -
���
MONTH
MONTH
DAY YEAR
(1 ADDRESS J U L�
CASH
$
I � may" L
CHECKS
$
CITY STATE ZIP
AMOUNT OF- r DOLLARS, AND CENTS TOTAL
�f/I
FOR PAYMENT OF: `��I�' L.� ZYi ' '
THIS RECEIPT 8 NOT V/AL[ LESS DATED, COM I TE❑ AND SIGNED BY AU ORIZED
DEPT.: 6`� L�-i7 r BY'
FOR OFFICE USE ONLY
OF.,,DEPARTMENT.
SUBSIDIARY INDEX CODE
■■■ ■■■■■■■■■ ■■■■■■■■■■■■ ■n■■ ■■■■■NONE
■■■ ■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■ ■■■■■■O■■.
■■■ ■■■■■■■■■ ■■■■■■■■■■■■ NOON■ ■■■■■■■■■
■■■ ■■■■■■■■■ ■■■■■■■■■■■■ NOON■ ■■■■■■■■■