DS-DE 12 Q2FLORIDA DEPARTMENT OF STATE, DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
Candidate, Committee or Party Name
Address (number and street) City
[] Check box if address has changed since last report
(4) C__he~ppropriate box(es):
I_~ Candidate (office sought): 1~,,~4~, ~e~-d~ {'(1'~
[] Political Committee
[] Committee of Continuous Existence
(2)
I.D. Number
State --Zip
[] Check if PC has DISBANDED
[] Check if CCE has DISBANDED
[] Party Executive Committee
Origefiod: From ~) z~ /
inal [] Amendment
($) REPORT IDENTIFIERS
[] Special Election Report
__ I ~)~ ReportType
[] Independent Expenditure Report
(6)
Cash & Checks
Loans
Total Monetary
CONTRIBUTIONS THIS REPORT
In-kind $ ~ ,
(g)
TOTAL Monetary Contributions to Date
(7) EXPENDITURES THIS REPORT
Expenditures $ , ,
Transfers to
Office Account $ , ,
Total Monetary
Other
(8) 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,
c°rrect and c°m~ ~r ~..-~ ~)~.~
xName of "~~rer
Signature
I certify that I have examined this report and it is true,
correct and complete
~/'Candidate [] Chairman (PC/PTY
Name of ~(~--~ O~ - //~
X
Signature
DS-DE 12 (910t)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
(',),-mo ¥'~ ~ g< ~"~ - (.) ,.,:,. ,,,.m,,,,r
{3) Cover Period O~-/ c2( / 02through Og/20 / O} (4)Page ( of
(5) (7) (8) ~9) (10) (11 ) (12)
Date Full Neme
(6) (Last, Suffix, First, Middle) Contributor
Sequence Street Address &
Number City, State, Zip Code Type Occupation TYpe Description Amendment Amount
/ /
/ /
//
~-- CAMPAIGN TR~EA~S~URER'S REPORT - ITEMIZED EXPENDITURES
(3} Cover Period ~ i o(' I O~ through ~D~ /..~ /. o~' (4)Page ( of (
{5) (7) (8) (9) ('10) (,i.~)
Date Full Name Purpose
(6) (Last, Suffix, First, Middle) (add office sought if
Sequence Street Address & contribution to a Expenditure
Number City, State, Zip Code candldata) Type Amendm~tt Amoullt
/ /
/ /
/ /
/ /
/ /
O~-LI~- ~4 ~[1~1 ~E=P- KE.V~=K~I= I-OK INb KUGIIUN~ ANU GfOIJI'' VALUI"~