Contributions Returned CONTRIBUTIONS RETURNED3 OcT
(Section 106.07(4)(b), F.S.)
(PLEASE TYPE)
This report applies only to contributions received by any candidate or committee, but returned to the
contributor before being deposited in the campaign account.
~ Candidate [] Political Committee [] Committee of Continuous Existence
FullName: ~'~F,.~
FullAddress:
Full Name and Address of Contributor:
Amount of Contribution:
Date Received: ~
Date Returned: ~
Full Name and Address of Contributor:
Amount of Contribution: $
Date Received:
Date Returned:
Full Name and Address of Contributor:
Full Name and Address of Contributor:
Amount of Contribution:
Date Received:
Date Returned:
$ Amount of Contribution: $
Date Received:
Date Retumed:
CERTIFY THAT I HAVE EXAMINED THIS REPORT AND IT IS TRUE, CORRECT AND COMPLETE.
Type or Print Name of Candidate, Treasurer or Chairman
Signature
DS-DE