F2FLORIDA DEPARTMENT OF STATE, DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
(2)
(,1)
Candidate, Committee or Party Name
(3)
I_.D. Number
Address (numl~.r and street) City State
[] Check box if address has changed since last report
(4) C__he/ck appropriate box(es):
~ Candidate(offices ought): ~d~., ,_~c~ ~',7'1~ ~/:~,~.~.i~,./-/ /
[] Political Committee
[] Committee of Continuous Existence
Zip Code
[] Check if'PC has DISBANDED
[] Check if CCE has DISBANDED
[] Party Executive Committee
(5) REPORT IDENTIFIERS
CoverPedod: From ~ / '~"~ / o~ To lo / (~) / ~ Report Type
[] Odginal [] Amendment [] Special Election Report [] Independent Expenditure Report
(6)
Cash & Checks $
Loans $
Total Monetary $
In-kind $
(9)
CONTRIBUTIONS THIS REPORT
TOTAL Monetary Contributions to Date
$__, I'Z., o3~. o~
(7) EXPENDITURES THIS REPORT
Monetary [
Expenditures $ , , __
Transfers to
Office Account $ , ,
Io0 . <5o
Total Monetary $-- , I , ~ o 0 5o
Other
(8) Distributions $ '~,
(10) TOTAL Monet~,y 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 [~reasurer [] Deputy Treasurer
x
Signature
I certify that I have examined this rel:~5~t aQ~ it is true,
correct and complete
Nameof [~andidate [] Chal~nan"~PCl~l~
Signature m co
DS-DE t2 (9/0t)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
~-- CAMPAI,~N TREASURER'S REPORT.iTEMiZED CO-NyRIBuTioNS
(1) Plante .,.~,,d~. K'"t'"' ~.Z~ (2) I.D. Number
(3) Cover Period, ? / ~-'~ /, ,,0:~ through /O__~_/ /O / ~ (4) Page ~ of ~
(5) (7) (8) '(9) (10) (11) (12)
Date Full Name
- '-:'""-(6)- ........ (La~t, SuffiX; First, Middle) Contributor
Sequence Street Address & Corttdbuflon In-kind
Number C,,ity, State, Zip Code Type Occ,_~_-~Jon Type Desc~pU~n Amendment Amount
CAMPAIGN TREASURER'S REPORT-ITEMIZED CONTRIBUTIONS
(1) Name ~'1~ ~ R-'t- ~q~'~ (2) I.D. Number
(3) Cover Period c) / 7-.'7 / O~ through [~P //l~ / ~)~ (4) Page 2-- of
(5) (7) (8) i9) (10) (11 ) (12)
Date Full Name
(6) (Last, Suffix, First, Middle) Contributor
Sequence Street Addres~ &
Conttlbm~o. In-kind
Number City, State, Zip Code Type Occupa~on Type D_~_c-riptlon Amendment Amount
/ /
/l
/ /
/?
CAMPAIGN TREASURER'S REPORT -.ITEMiZED EXPENDITURES
(1) Name ' ~'u~r {~ (2) I.D. Number
(3) CoverPerlod ¢~ / '2.'~[ 03 through (o~ (~ ~ ~ (4) Page ( of
(s) (7) (8) (9) Ho) (1,1)
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 candidate} Type ~nendment Amount
~/(/o:~ L~
/ /
//
/ /
/ /
/ /
J.,.~lJI- qR. { IPJUI ~r,'l= K~'Vl:ff~l: PUK IN~ I KUG[IUNtJ ANIJ GUIJI= VAI. UP-~J