DS-DE 12 F2-09 SeguiFLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) `~C~ ` , ' ~~F IC ''U ~-ONLY
ame
(2) ~ yv ~ ~~~-.~ s ,~~~ Z009 OCT -2 PM 2~ 22
Ad ress (number and street) ~,~T~r' [;~_~ r~:.`.`~ ~i~~- ~~~~
~ a c-a
City, State, Zip Code
^ CHECK IF ADDRESS HAS CHANGED
(4) Check appropriate box(es):
~ Candidate (office sought):
^ Political Committee
^ Committee of Continuous Existence
^ Party Executive Committee
^ Electioneering Communication
(3) ID Number:
Ski ~~ ~i-or~I "~
^ CHECK IF PC HAS DISBANDED
^ CHECK IF CCE HAS DISBANDED
^ CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS
Cover Period: From ~ y l (~ l G y To ~_ / ~5 / ~ Report Type ~~ p
[~, Original ^ Amendment ^ Special Election Re ort
p ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT
Cash & Checks $ -~
Loans $ ~'~
Total Monetary $
In-Kind $
(7) EXPENDITURES THIS REPORT
Monetary
Expenditures $ Ll~j~
Transfers to Office
Account $
Total
Monetary $ /~~r'
(8) Other Distributions
$
(9) TOTAL Monetary Contributions To Date (10) TOT Monetary Expenditures To Date
$ 7 3 ~ $ °~
ry3~~
(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 t have examined this report and it is true,
correct, and complete. correct, and complete.
(Type name)
^Individual (only for ~fe~surer ^ Deputy Treasurer
electioneering
X
Signature
(Type name)
^ Candidate Chai erso my for PC, PTY 8
electio nn un. organization)
X
Signature
DS-DE 12 (Rev. 08/04)
~~4~ ~~ ~
C MPAIG~TREAS.URER'S REPORT -ITEMIZED EXPENDITURES
(1) Name ~ ~~ (2) I.D. Number
(3) Cover Period ~_//o~ /~_ through ~_/~_/~~
(4) Page of
(5)
Date (~)
Full Name ($)
Purpose (9) (10) (11)
(g)
Sequence
Number (Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code (add office sought if
contribution to a
candidate)
Expenditure
Type
Amendment
Amount
~~ ~~~~
DS-DE 14 /Rev_ O R/A31
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
~~~ 2~ ~