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DS-DE 12 F1-09 Mayer
FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) M ~ ~.". M ~~„ OFFICE USE OILY ~°o ~ P ., ., r,/~ "t~ Address (number and street) "~° ~ •-' .~- ~,, City, State, Zip Code -~ r ^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: ~,? ~ (4) Check appropriate box(es): ~andidate (office sought): ~~ ~( ~ G'nMM(~bl~- ~Ro~ ~. ^ 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 ~ / ( / Qq To ~' / (~ / (~( Report Type ~ (-- ~~ Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary Cash & Checks $ ,~1j „~„ Expenditures $ ~ ~ 2,(''~. 00 Loans $ Q ,per, pp Transfers to Office Account $ ""'~ Total Monetary $ --~ Total Monetary $ ~--- In-Kind $ -~" (8) Other Distributions $ '--.' (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ ~I X00. Oct $ I , 0 2 c7 , OD (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) Nti(~..1 ~ (Type name) ~I/)~,~ q- M ~'~t~- ^Individual (only for ©Treasurer Deputy Treasurer ~ Candidate ^ Chairperson (only for PC, PTY & electione g commun.) electioneering commun. organization) X X Signat a Signature DS-DE 12 (Rev. 08/04) ~ ' CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name M iA'fL( tAc I~) A~1 L'~ (3) Cover Period ~ / ( / ~ l through ~ / ~ (2) I.D. Number / ~ ' (4) Page ~ of 1 (5) Date (7) Full Name (8) (9) (10) (11) (12) (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 Amendment Amount q ~~ l ~~ M A~.~ik- mq~teR (~ 1 ~C N , cT~P~C1,Jbr~ PNfc„ ~ M I LE Mt Pj~,l{ ~- ,.~" ~a~~ GL y ~~ ~ z,~.o D5-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES P~~~-~ CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name N1~.lA' M1~'`i~R- (2) I.D. Number (3) Cover Period ~/~_/~~ through - t / ~ ~ /~q (4) Page ~ of (51 Date (~) Full Name ($) Purpose (9) (~o) (~~) (s) Sequence Number (Last, Suffix, First, Middle) Street Address 8~ City, State, Zip Code (add office sought if contribution to a candidate) Expenditure Type Amendment Amount I l fl TY of Mt inn t ~t~t 01 l~0 Con/~+ttte-n ~,rv2 Mtgrn( ~ t~ ~ 33 Q~Ik~t ~Y Irv( MAN 1, 020. DS-DE 14 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES P~ 3~