DS-DE 12 FLORIDA DEPARTMENT OF STATE, DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
/ . ,-
(1) ~ /<. ~~ ~ /~ ..~,~, u
Candidate, Committee or Pa~y Name t~ I.D. Numbe~"
Address (number and street) City State Zip Code
~Ch~k ~x if address has chang~ since last re~d
(4) ~.,.~k appropriate box(es):
I~1 Candidate (office sought):
I-]Political Committee
["-~ Committee of Continuous Existence
-]Party Executive Committee
~-] Check if PC has DISBANDED
'--]Check if CCE has DISBANDED
(5) REPORT IDENTIFIERS
Cover Period: From -~ / !?/ .~ To ~ / ~'/ /
I~Original ~ Amendment r--I special Election Report
(6) CONTRIBUTIONS THIS REPORT
Cash & Checks $ , ,
Loans $ .... ,.~"',P O.
Total Monetary $ ,
In-kind $___ .....
(9) TOTAL Monetary Contributions to Date
- $ , ., 5-¢ ¢ .
Report Type (~ /
E~] Independent Expenditure Report
(7) EXPENDITURES THIS REPORT
Monetary
Expenditures $__, ,
Transfers to
Office Account $ .....
Total Monetary S_z, ,__ .__
(8) Other Distributions $ , ,_
(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, correct and complete
Name of J--~Treasurer [-"'] Deputy Treasurer
Signature
I certify that I have examined this report and it is
true, correct and complete
Name of ~'~Candidate [~ Chairman(PC/PTY
Only)
X
Signalure~r
}S-DE 12 ('7/98)
SEE REVERSE FOR INSTRUCTIONS AND cnnF vAi iir:g
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
~lame ,~-~','.~ /~. ~'~t'~/,~ v/'~,~. (2) I.D. Number
~overPeriod 3 / / 7 / .~ through ~ / 3/ / ..~ (4) Page 2/ of
(5) (7) (8) (e) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle) Contributor
;equenco Street Address & Contribution In-kind
Number City, State, Zip Code TypeOccupationType Description Amendment Amount
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E 13 (7198~ SEE REVERSE FOR INS'rRUCTION; AHn ~..nnl= vA, I'r_~ ~/~ '~
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
Name .'~-~,/5' ,~ ~',~',,cer,,,~' v/~ (2) I.D. Number
Cover Period -~ //7 / ~ through '~ / ~'/ / -~ (4)Page ~'- of
(s) (?) (a) (9) (10)
Date Full Name Purpose
(6) (Last, Suffix, First, Middle) (add office sought if
;equence Street Address & contribution to a Expenditure
Number City, State, Zip Code candidate} Type Amendment Amount
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~ 14 (7/98) SEE REVERSE FOR INSTRUCTIONR ANn ~.nnr