DS-DE 12 Q1-12 Urquiza FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) ISC, �l��y;�U OFFICE USE ONLY
Name
(2) 2_Z4
Address (number and street)
Fl S3 \ICA
City, State, Zip Code
❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number:
(4) Ch ck appropriate box(es):
[Candidate (office sought): ( ,,,nw+;ss s Uj o b Z
❑ 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 O / O � / ZC lZ To p3 / 3( / ?0Q Report Type
Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ Expenditures $
n N
O
Loans $ Transfers to Office N 70
Account $ r, nv I
Total Monetary $ Total
Monetary $ -
In-Kind $ 16
(8) Other Distributions
$ � cN.n
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ S poo $
(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) C f J G ✓1�0 S (Type.name)
❑Individual(only for ZTreasurer ❑Deputy Treasurer Candidate ❑Chairperson(only for PC,PTY&
electioneering commun.) ^ electioneering commun.organization)
y � 1
Signature Signature
DS-DE 12(Rev.08/04)