DS-DE 12 F2-09 MayerFLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMM 1C -
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(1) M Pt~t q- ~~~((7YL_, OFFICE USE ONLY
Name 2004 OCT -2 p{~ 4: S2
(2) ~~ h1. ~C ~nS ('~N PIS -
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Address (number and street)
M t ~Ml P~L~iAf,{~. ~ ~ ~ l ~
City, State, Zip Code
^ CHECK IF ADDRESS HAS CHANGED (3) ID Number:
(4) Check appropriate box(es):
[
Candidate (office sought): Ml RMl QSc~i+ (~DMIN1tgSIoNE}2 ~QOt,Q~C
^ 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 ~( / ~ / p!.'~ To ~ / ZS / C7~ Report Type ~-Z~
~iginal ^ Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPbRT
Monetary
Cash & Checks $_ l~ , 3 b Expenditures $ ~ ~rj aD . 0 (~
Loans $ 2~ ~ 00~ Transfers to Office
Account $ .--,
Total Monetary $ /~t 33 ~ Total
Monetary $ ~ tj p O, o a
In-Kind $ ~
I
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ _ 3 2, 33 h $ ~ ~,5~
(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) M ~ ~.l A- ~ ~ C, D~--- (Type name) M ~, t ~ ~1/L
^ Individual (only for ®Treasurer ^ Deputy Treasurer
l ~ Candidate ^ Chairperson (only for PC
PTY &
e
ectioneering commun.) ,
electioneering commun. organization)
X X
Signat Signat
flC_f1C ~7 /o.... Hein ~.
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CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
(1) Name (V~~,~~ 1`(1 PI'`'1E 2' (2) I.D. Number
(3) Cover Period ~ / ~Z / da through ~ / [~ / ~ (4) Page
~ of
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Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number Cit ,State, Zi Code T e Occu ation T e Descri tion Amendment Amount
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CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
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(3} Cover Period ~ / ~2- / fl°~ through ~ / ~ / ~ (4) Page
2 of 6
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ta T e Occu ation T e Descri tion Amendment Amount
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CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
(1) Name rn ~.( ~M ~~ (2) I.D. Number
(3) Cover Period ~ / (2 / p~ through ~ f ~ / ~ C( (4) Page .3 of
', (5) (7) (8) (9) (10) (~~) (12)
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(6)
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CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
(1) Name N~q~2.1 A- M ~y~ (2) I.D. Number
(3) Cover Period ~ / ~ Z / ~~ 4 through ~ ! ~ / ~~ (4) Page ~ of
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SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
(1) Name M KI`~ /~' iM ~ ~ ~ (2) I.D. Number
(3) Cover Period ~ / ~ 2- / ~~ through ~ / 1-S~ / O 1 (4) Page ~ of
(5)
Date (~)
Full Name ($) (9) (10) (~~) (~2)
(6)
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Number (Last, Suffix, First, Middle)
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Cit ,State, Zi Code
Contributor
T e Occu ation
Contribution
T e
In-kind
Descri tion
Amendment
Amount
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DS-DE 13 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
PA~~~~~
CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES
1 Name ~ ~ ~I ~ M ~~ E ~ (2) I.D. Number
() 1
(3) Cover Period ~ / ~ ~/ ~~ through t/ ~S / ~~ (4) Page t of
(5)
Date (~)
Full Name
l (8)
Purpose
ht if
add office sou (9) (10) (11)
(s)
Sequence
Number e)
(Last, Suffix, First, Midd
Street Address &
City, State, Zip Code g
(
contribution to a
candidate) Expenditure
Type
Amendment
Amount
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DS-DE 14 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES