F3FI..ORIDA DEPARTMENT OF STATE, DMSION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
Candidate, Committee ~ P.arty Name
[] Check box if address has changed since last report
(4) _Chec~pprophate box(es):
LU'Candid,.t,.(ofr.: so. ght): ,/wh
(~)
I.D. Number
State 7{p Code
[] Pol~ Committee [] Check if PC has DISBANDED ~.'--: -~
[] Commil~ee of Continuous Existence [] Chec~ if CCE has DISBANDED ~ -- ~
|$) REPORT IDENTIFIERS
~O~: From 10 / (( / ~)*~ TO '(2 / ~0 I
inal [] ,~am~ndrr~nt [-] Sp~al El~::tion Rel:~'t [] Independent Expenditur~ Report
(6)
Cash & Checks
Loans
Tofal Monetary
In-kind
(9)
CONTRIBUTIONS THIS REPORT
$ , I .
$ , ,
TOTAL Monetary Contributions to Date
{7) EXPENDITURES THIS REPORT
Mmeta~
Expenditures $__, .~',
Tra,-~;~Ks to
O~ce Account $ , ,
(8) Distributions $
(10) TOTAL Monetary F. xpendRures to Date
$~, I?-- , ~z9 .
(11) CERTIFICATION
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
! certify that I have examined this report and it is true,
correct and complete
Name ofSignatureX ~T~sumr.
: I certify that f have examined this report and it is true,
correct and completeC.
Name of .~CandidRt~ [] Chairman (PC/PTY
DS-DE 12 (9/01)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
~- CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS
(1)Mmm~ ~'G'o~._'~- ~ (2)l.D. Number
{s) (7)
G~ Full Name
16) 0-ast, Suffix, first, Mlddte) C~mtribut~
~mquence Street Address &
/'~ CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
(.,)N,.. Nu,.,,e,
(3) Cover Period ~-~ / ( ~, / ~ through (4D / ~ / D '~ (4,) Page ~ of, "~
(S) (7) (8) (9) (10) (11) (12)
I~, Full Name
(6) (Last, Suffix, Firet, Middle)
Sequence Street Address & Comdbutkm In-kind
Numb4w City, State, Zip Code ?ype O~Uon Type Description Amendment Amount
(~) Name ~ ~ l'~,:, ~-..~.~..~ ' (2} I.D. Number
(s} (71 (;) P) 0o) (~)
(6) ~ suffix, First, ~le) (~ ~ s~g~ ~
/ /
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