HomeMy WebLinkAboutDS-DE 12 (1)
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· FLORIDA DEPARTMENT OF STATE, DIVISION OF ELECTIONS
CAMPAIGN TREASU ' SUMMARY
~ah~dat~, Commi~ee or Pa~ Name U~ ~ I u ~n o: o~ I.~Nd~
Ad~r~ss'(ndm~r a~eet) '~
~ Che~ ~x ~ addr~s has ~ang~ sin~ last
Check appropriate box(es):
[~ Candidate (office sought):
[] Political Committee
[] Committee of Continuous E.,dstence
Party Executive Committee
Cover Period:
~ Odginal
(5) REPORT IDENTIFIERS
From~ To ,~/,,~///~,~
[] Amendm~/nt I [] Special Election Report
Zip Ccd&
[] Check if PC has DISBANDED
Check if CCE has DISBANDED
Report Ty. pe:
[] Independent F-xl:~nditur~r*aR~port
(6) CONTRIBUTIONS THIS REPORT
CaSh & Checks $ ,
Loans $ //~
Total Monetary $ //'~ ~
,n-Kind $ /J/~
(9) TOTAL Monetary Contributions to Date
(7) EXPENDITURES THIS REPORT
Monetary ~//~
Expenditures $ '
Transfers to OfficeAccount $ ,/~ .~
Total Monetary $ /~h
/ -
(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 cerlJfy that I have examined this report and it is
true, correct and comDlete
Nagg, '"13 "e";""'
Signat,',r$ / ..... t -
I cerUfy that I have examined this report and it is true.
Name ;f/ -' dCha-'"-irm~n (PC/P"~ only)
$ig:natur'e ' /
)S-DE 12 (7/98)
SEE REVERSE FORINSTRUC~ONSAND CODE VALUES
CAMPAIGN TREASURER'S REPORT-ITEMIZED CONTRIBUTIONS
(1) Name / E .................. (2) I.D. Number ~7/~
{3) Cover Period / / through ~ / ~/ / ~) -~ // of
(s) (7) (8} (9) (t0) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle) Contributor
Sequence Street Address &
~n In-kind
Number City, State, Zip Code Type Occupa~on Type Description Amendment Amount
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