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FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT IVE � (- �) -t
(1) Reformm.com OFFF,C�E tor bNO
Name 2011 AP 1
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(2) 7455 Collins Avenue, Suite 212 �� GL
Address (number and street)
Miami Beach, F1 33141
City, State,Zip Code
❑CHECK IF ADDRESS HAS CHANGED (3) ID Number:
(4) Check appropriate box(es):
❑ Candidate(office sought):
Political Committee ❑CHECK IF PC HAS DISBANDED
❑ Committee of Continuous Existence ❑CHECK IF CCE HAS DISBANDED
❑ Party Executive Committee
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(5) REPORT IDENTIFIERS
Cover Period: From of / 01 / 2012 To 03 / 31 / 2012 Report Type Ql
dOriginal ❑Amendment ❑ Special Election Report ❑ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash &Checks $ 0. 00 Expenditures $
Loans $ 0.00 Transfers to Office
Account $ D 00
Total Monetary $ 0. 00 Total
Monetary $ /�,�� �(
�
In-Kind $ 0.0 0
(8) Other Distributions
$ O .p
(9) TOTAL Monetaryontributions To Date (10) TOTAL Monetary Expenditures To Date
(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. f ,
(Type name) W6 A, (Type name)
❑ reasurer Deputy Treasurer ❑Candidate hairperson(only for PC,PTY&
X X tL
Signature Si atu
DS-DE 12(Rev.08/04)
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„�- - MIAMI SH,
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