DS-DE 12 F1-09 Campaign Treasurer's Report SeguiFLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) ~,' OFFICE USE ONLY
Name
(2) ~yD l ~ ~/~ ~S ~F
Address (number and treet~ ~ ~-'
~
-- ?
V?
City, State, Zip Code - y~..t
~~'
^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: c;
(4) Check appropriate box(es): ,,, ~:~
~
^ Candidate (office sought): ~ ~`~`'p
~ -'
^ Political Committee ^ CHECK IF PC HAS DISBANDED _ _
-
^ Committee of Continuous Existence ^ CHECK IF CCE HAS DISBANDED ~'
^ Party Executive Committee
^ Electioneering Communication ^ CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS
Cover Period: From QZ / p( / ~ To ~ / ~ ( / ~ Report Type ~ j - O
^ Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ ~ Expenditures $ `~a~'=
Loans $ J~"BoC~ dG Transfers to Office
Account $
Total Monetary $ sa~~ ~` Total
Monetary $ l G
~ ~a °-
In-Kind $ ~~
(8) Other Distributions
$ ~"
(9) TOTAL Mon
et
a
ry Contributions To Date (10) TOTAL Monetary Expenditures To Date
c
/
~
$ 7,3 J (/ $ C ~~ ~ v
(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, I certify that I have examined this report and it is true,
correct, and complete. correct, and complete.
(Type name) O~~ ~ ~ ~ (Type name) b S'
^Individual (only for __ Treasurer Deputy Treasurer Candidate rperso (only for PC, PTY &
electioneering com ecf ~ng commun. organization)
X ~/ X -~
Signature Signature
DS-DE 12 (Rev. 08/04)
r n~c~ i ~-3
CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
c% o
(1) Name c./} (2) LD. Number cn
(3) Cover Period ~/ / ~ / ~ through ~ / // / D ~ (4) Page - ofr~ ~ }~`
J.
Date Full Name -
(6)
Sequence
Number (Last, Suffix, First, Middle)
Street Address &
Cit ,State, Zi Code
Contributor
T e Occu ation
Contribution
T e
In-kind
Descri tion
mendment U1
~,
Amount
l
~YS ~~~ Ea~F/
,~cG emu,. ,.,~.t,/
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(~~GE 2 ~-3
MPAIG~I~ R USURER'S REPORT -ITEMIZED EXPENDITURES
(1) Name (2) LD. Number ___ ....,
~,~ _µ
(3) Cover Period ~~/ O ( /~ through B~ l ~ t l~ (4) Page of ~~:_
~~ i
Date Full Name Purpose ~ °~
lsl
Sequence
Number (Last, Suffix, F(rst, Middle)
Street Address &
City, State, Zip Code (add office sought if
contribution to a
candidate)
Expenditure
Type
Amendment fr-~
~` Aro~unt -'-
••
~ Q c~ ~ v~
o~ ~~lf~s ~-~
s ~vc~4 (f ~
Abu Q~
~~~
y
33 Ya (~ e s
DS-DE 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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