DS-DE 12(1)
FLORIDA DEPARTMENT OF STATE, DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT S~/E.
Candidate, Committee or Party Name
(3)
Address (number and street) City
r-'l Check box if address has changed since last report
(4) Check appropriate box(es):
[-"~andidate (office sought):
~'1 Political Committee
r'--J Committee of Continuous Existence
["-! Party Executive Committee
State Zip Code
F'-] Check if PC has DISBANDED
--']Check if CCE has DISBANDED
(5) REPORT IDENTIFIERS
Cover Period: From .2 / ,2~71 ~ To ..'~T / .'~/ / ~._~ ReportType ~'
[~' Odginal ~J Amendment r'~ special Election Report [] Independent Expenditure Report
Cash & Checks
Loans
Total Monetary
In-kind
(6) CONTRIBUTIONS THIS REPORT
$ , ,=¢2c. z ~'
(9) TOTAL Monetary Contributions to Date
- $__, ,_5~"c, . ,~ ~
(11) CERTIFICATION
(7) EXPENDITURES THIS REPORT
Monetary
Expenditures $__, , ~
Transfers to
Office Account $__, ,__
Total Monetary $ , ,__
(8) Other Distributions $ , ,__
(10) TOTAL Monetar to Date
$ ,
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 repod and it is
true, correct and complete
Name of r'-] TreaSurer ~-] Deputy Treasurer
I certify that I have examined this report and il is
true, correct and complete
Nameof ~-~Candidate ~ Chairman(PC/PTY
Signalure
Only)
DS-DE 12 (7/98)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TReaSURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name ~?~--'~.~ ~,-,, ~_.'~ o-~__ (2) I.D. Number
(3) Cover Period / / through .-~ / ~/' / _~ (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, Flint, Middle) Contributor
Sequence Street Addres~ & Contribullon In-kind
Number City, State, Zip Code TypeOecupeflon Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
//
DS*DE 13 (7/98) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES