DS-DE 12· FLORIDA DEPARTMENT OF STATE, DIVISION OF FI ECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
Candidate, Committee or Party Name
Address (number and street) City
[] Check box if address has changed since last report
(2)
I.D. Number
(4)
Check appropriate box(es):
r-] Political Committee [] Check if PC has DISBANDED
[] Committee df Continuous Existence [] Check if CCE has DISBANDED
Party Executive Committee
Cover Period:
r~ Odginal
From I/I /0~ TO~
[] Amendment [] Special Ele~on Report
L
Total Monetary
,n-Kind
(6) CONTRIBUTIONS THIS REPORT
& Checks $ 0
(9) TOTAL Monetary Contributions to Date
50 lo o
[] Independent Expenditure Report
(7) EXPENDITURES THIS REPORT
Monetary
Expenditures $. 0
Transfers to Office ~)
Account $.
Total Monetary $, 0
(8) Other Distfibu~Jons
$ 0
(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 ~at I have examined this report and it is
~ue, corTect and complete
.
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
I cer'dfy ~a~ I have examined this r,eport and it is true,
correct and complete
-. CAMPAIGN TREASURER'S REPORT-ITEM[ZED CONTRIBUTIONS
,~CoverPeri~ I / J / 0~r~gh ~/ ~1/ O~ I of
Da~e Full Name
(6) (Las1, Suffix, First, Middle} Contributor
Sequence Street Address & ComrlbutlonI In-kind
Number City, State, Zip Code TypeOccupation Type D~e$cflption Amendment Amount
;/~/~¢
~J/~ LO~4
I
/ /
/ /
/ /
/ /
/ /
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' CAMPAIGN TI~EASURER'S REPORT-ITEMIZED EXPENDITURES
(~)Name J~)~0J~ ,.~. ~D~--' ' (2)l,D. Number
(, ,over Period I/
I/ 0~rough ,~/,~1/ 0,~ (4) Page I of. J
(5) (7) (8) (9) (10) (11)
Date Full Name ':' Purpose
(6) (Last, Suffix, First, Middle) (add office sought ff
Sequence Street Address & contribution to · Expenditure
Number City, State, Zip Code candidate.) Type ~ Amount
I
/ /
/ /
/ /
/ /
/ /
/ /
CAMPAIGN TREASURER'S REPORT- FUND TRANSFERS
" ,me ~J ~ ~D ~:) '~]. ~ 07~., ~ (2) I.D. Number
~) C~ver Period / / ! / 0~through ,~ / ,~// 07:~ (4) Page / of J
(7) ~. (8) (s) (4 o) (~ ~ )
(s)
Date Name of Financial
(6) Institulion
Sequence Streel Add _~___~ & Transfer Nature of
Number Cily, State~ Zip Code '[ype Accounl Amendment Amount
/ /
/ / -
/ /
/ /
/ /
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