TR 02/04/2002 FLORIDA DEPARTMENT OF STATE, DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
F']Check box if address has changed since last report
(4) Check appropriate box(es):
~Candidate (office sought):
~]Political Committee
r"] Committee of Continuous Existence
""}Party Executive Committee
r']Check if PC has DISBANDED
F']Check if CCE has DISBANDED
(5) REPORT IDENTIFIERS
Cover Period: From/I i ,~,,2 I ~/To ~),-~/~/~,Z~. Report Type
~ Original
(6) CONTRIBUTIONS THIS REPORT
f"'] Amendment
{"~Special Election Report ~ Independent ExpenditL~'~ R~ort
(7) EXPENDITURES THIS REPORT
Monetary
Expenditures
Cash & Checks $__, , D. ~ ~
Loans $ .... .
Total Monetary $ ....
In-kind $ ....
Transfers to
Office Account $__, ,
m
Total Monetary $.._ .... .
(8) Other Distributions $ ....
(9) TOTAL Monetary Contributions to Date (10) TOTAL Monetary Expenditures to Date
$ , ,.7, r, 75. Or) $ , ,R,~t~/- 2rz~
(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,
correct and complete
I certify that I have examined this report and it is true,
correct and complete
Name of [~ Candidate
X
Signature
F"~Chairman (PCIPTY
Only)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
DS-DE 12 (02/97)
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
/
(5)
Date
(6)
~ltqusnc~
Number
(7) (8) (9)
Full Name Purpose
(Last, Suffix, First, Middle) (add office sought if
Street Addrose & contribution to a Expenditure
City, State, Zip Code candidate) Type
~lbErJra /~a~ / ) (--Trellis,& HoD
(~o)
Amendment
I/ i/61~/ /421~/~ /~s~ll
/1//9 I~ I
/d,'~H,', P/on'd,4
I//171a /
/
(11)
Amount
/Sa. ~o
/ /
/ /
/ /
C~
(1) Name
(3) Cover Period
(s)
Date
(6)
Sequence
Number
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
///~J ~//through~ . __
(7)
Full Name
(Last, Suffix, First, MIddle)
Street Address &
CIty, State, Zip Code
(8)
Contributor
(2) I.D. Number
<.> ..0e / o, /
(9) (10) (11 )
Type Occupation
Contribution In-kind
Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(1) Name
(3) Cover Period __ __
(5)
Date
(6)
Sequence
Number
CAMPAIGN TREASURER'S REPORT - FUND TRANSFERS
(2) I.D. Number
/ /__ through __ __ __
/ (4) Page
(7) (8) (9)
Name of Financial
Institution
Street Address & Transfer Nature of
City, State, Zip Code Type Account
Of
(10)
Amendment Amount
/ /
/ /
/ /
/ /
/./
/ /
/ /
/ /
DS-DE 94 (7/g81 SEE REVERSE FOR INSTRUCI'IONS AND CODE VALUES